To the Editor:—
Severe hypotension developed during the administration of albumin 5% (human) after cardiac surgery in a patient known to have an allergy to eggs. Blood bank personnel questioned the advisability of giving albumin to any egg-allergic patient, and the patient's medical record was labeled with “albumin allergy.” We were thus prompted to study the validity of the presumed association.
The proteins from the whites of eggs are collectively referred to as album en
are any water-soluble proteins that, like albumen, form a white coagulum when heated. Ovalbumin (45 kd), the principal protein of egg albumen, is a different protein from human serum albumin (67 kd). A distinct lactalbumin occurs in milk, and other albumins are found in muscles and plants. A person allergic to all albumins would be hard pressed to find sustenance.
A person allergic to pure human serum albumin would also have a difficult situation. Albumin is the most abundant of the plasma proteins. However, 5% albumin is not a pure entity, and adverse reactions are reported. 2
Prekallikrein activator is sometimes a deleterious component, though seldom a concern in modern preparations. 3
Bacterial contamination can occur, but cultures of the contaminated bottle were sterile.
Withholding serum albumin-containing products from egg-allergic patients is tantamount to withholding propofol from penicillin-allergic patients because of the letter “p.” Fleming, by the way, named penicill in on the hunch that the antibiotic might prove to be a prote in. The suffix “in” is therefore carried by most antibiotics today. Thankfully, no adverse reactions coincided with administrations of vancomyc in, nitroglycer in, or digox in to our patient.
Samuel J. Smith, M.D., M.P.H.*
Dwight Geha, M.D.
Theodore A. Alston, M.D., Ph.D.
1. Simpson JA, Weiner ESC: Albumen, Oxford English Dictionary, 2nd edition, volume 1. Oxford, Carendon Press, 1989, p 298
2. Stafford CT, Lobel SA, Fruge BC, Moffitt JE, Hoff RG, Fadel HE: Anaphylaxis to human serum albumin. Ann Allergy 1988; 61: 85–8
3. Howard G, Downward G, Bowie D: Human serum albumin induced hypotension in the postoperative phase of cardiac surgery. Anaesth Intensive Care 2001; 29: 591–4
© 2003 American Society of Anesthesiologists, Inc.