Human serum albumin


Used as a plasma expander, in plasma exchange and for pulmonary perfusion scan (technetium 99 m labeled human albumin microspheres).
 
Incidence
0.012%.
 
One third of reactions are life-threatening.
 
Clinical manifestations
Anaphylactic shock..
 
Bronchospasm.
 
Pruritus, urticaria.
 
Diagnostic methods
Cutaneous testing
 
Intradermal skin tests with undiluted human serum albumin leads to false positive results.
 
Some authors reported positive skin tests with dialysed, undialyzed and ultracentrifuged HSA 0.5% and 5%.
 
Specific IgE (ELISA).
 
Mechanisms
IgE-mediated hypersensitivity is suggested by immediately positive cutaneous tests and evidence of specific IgE.
 
Albumin aggregates (high molecular weight aggregates and some denatured albumin-globulin complexes may form during preparation of albumin solution).
 
IgG anti IgA in IgA-defective patients.
 
Complement activation.
 
Management
Avoidance.

References

  1. Stafford CT, Lobel CA, Fruge BC, Moffitt JE, Hoff RG, Fadel HE, "Anaphylaxis to human serum albumin", Ann. Allergy 1988; 61 (2), 85–8. 
  2. Edelman BB, Straughn MA, Getz P, Schwartz E, "Uneventful plasma exchange with albumin replacement in a patient with a previous anaphylactoid reaction to albumin", Transfusion. 1985; 25: 435-6
  3. Littenberg RL, "Anaphylactoid reaction to human albumin microspheres", J. Nucl. Med. 1975; 16 (3): 236-7

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