Sulfated surfaces in sensitivity: an 'on-off' switch for anaphylaxis?

Activation of the plasma contact system with the production of bradykinin appears to play a role in X-ray contrast material reactions and in some forms of anaphylaxis. We have noted that the plasmas of contrast material reactors and some asthmatics show an accelerated rate of contact activity when exposed to exogenous contact activators at low temperatures, and we have identified two plasma priming substances (endogenous contact activators; ECA) that contribute to this potential activity. One primer appears to be a sulfated polysaccharide or proteoglycan that resembles heparin and/or heparan sulfate in its properties. Plasmas containing this primer show a cold-promoted activation of factor VII (CPA) as described by Gjonnaess (Thromb. Diathes. Haemorrh. 1972; 28: 169-181) and found particularly in high estrogen states. These plasmas also show spontaneous amidolytic (contact system) activity on cold incubation, and potentiated amidolytic activity when exposed to exogenous sulfated negative surfaces. A consideration of these findings and data in the literature suggest that these surfaces may originate on endothelial linings, may be increased in concentration by immunization and estrogens, and decreased by corticosteroid pretreatment. These considerations merit further study and may be the basis for the observed increase in asthma/allergy symptoms in some females during high estrogen periods.