Gelatins are used as plasma expanders in emergency situations. Fluid gelatins are produced by hydrolysis of collagen and chemical modification:
- succinylation (modified fluid gelatin);
- cross-linking with glyoxal and subsequent degradation by oxidation and heating (oxypolygelatin);
- cross-linking with hexamethylene diisocyanate (urea linked gelatin).
Gelatins linked to urea: 0.146% to 0.852% administrations (0.048% of serious manifestations).
Oxypolygelatins: 0.617% of administrations.
Modified fluid gelatins: 0.066% to 0.338 % of administrations (0.016% of serious manifestations).
Gelatin allergy (gummy bears, sweets/foods such as liquorice, marshmallows, corned beef, brawn, fruit yogurt, instant whipped cream, instant pudding, juices).
General: anaphylactic shock
Cutaneous: urticaria +++.
Classification of allergic reactions:
I urticaria, flush
II same + nausea +dyspnea + tachycardia, arterial hypotension
III same + vomiting, diarrhea + bronchospasm + cyanosis + shock
IV same + respiratory arrest + cardiac arrest
Intradermal skin-tests: positive from 1/1000 to 1/10 in a few patients with anaphylactic shock
Specific IgE (ImmunoCAP/Pharmacia CAP System).
Histamine-release by blood basophils.
Direct histamine-release (urea linked gelatins by excess of diisocyanate)
Antihistamines H1 and H2 are useful in prevention of minor cutaneous reactions.
Avoidance of gelatins.