Bovine serum albumin


Bovine serum albumin is a powerful immunogen able to produce allergic reactions. It is used during bone marrow transplantation and in vitro fertilization.
 
Incidence
Serum sickness: 1% to 15% (in 32 patients with in vitro fertilization).
 
Risk factors
Atopy.
 
Clinical manifestations
Anaphylactic shock.
 
Urticaria, angioedema.
 
Rhinoconjunctivitis.
 
Bronchospasm.
 
Serum sickness (maculopapular eruption, arthralgias, fever, 8 to 12 days after procedure).
 
Diagnostic methods
Cutaneous testing.
 
Skin prick-tests: positive with BSA in 1% distilled water.
 
Intradermal skin tests with BSA 0.1 and 1 mg/ ml are positive in immediate and late responses, and positive to fetal calf serum (containing bovine serum albumin).
 
Specific IgE: IgE anti BSA (ELISA / RAST).
 
Specific IgG (ELISA) in serum sickness-like reactions.
 
Mechanisms
IgE-mediated hypersensitivity: positive skin tests and specific IgE against BSA. Sensitization to BSA may develop following natural contact (eating meat, drinking cow’s milk, exposure to animal epithelia, dander or saliva containing serum albumin cross-reactive with BSA)
 
Serum sickness-like reactions: IgG 1 mediated sensitization to BSA
 
Management
Preoperative skin prick tests or RAST with the insemination medium is recommended.
 
Concerning bone marrow infusion, autologous plasma or serum is now used instead of BSA.

References

  1. Wüthrich B, Stern A, Johansson SGO, "Severe anaphylactic reaction to bovine serum albumin at the first attempt of artificial insemination", Allergy. 1995;50: 179-83
  2. Morales C, Braso JV, Pellicer A, Ruiz A, Pelaez A, "Serum sickness due to bovine serum albumin sensitization during in vitro fertilization", J. Inv. Allergol. Clin. Immunol. 1994;4 (5): 246-9
  3. Moneret-Vautrin DA, Wal JM, Guillet-Rossof F, Gerard H, Boulard P, "Bovine serum albumin immunization. A new risk of allergy during protocols for in vivo fertilization", Allergy. 1991; 46: 228-34
  4. Macy E, Bulpitt K, Champlin RE, Saxon A, "Anaphylaxis to infusion of autologous bone marrow. An apparent reaction to self mediated by IgE antibodies to bovine serum albumin", J. Allergy Clin. Immunol. 1989; 83: 871-5

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.