A patient with anaphylaxis after alteplase infusion

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Intravenous thrombolysis with alteplase is a critical treatment for acute ischemic stroke.
• Anaphylaxis is a rare but serious adverse reaction to alteplase therapy.

Observation:

• A patient experienced anaphylaxis following both an initial bolus and a delayed infusion of alteplase.
• The reaction necessitated intensive care unit admission and treatment with standard anaphylaxis protocols.
• Serum tryptase levels showed a modest increase, supporting a clinical diagnosis of anaphylaxis.

Findings:

• Anaphylaxis to alteplase, though uncommon, is a recognized complication of thrombolytic therapy.
• Serum tryptase levels may not always be significantly elevated in drug-induced anaphylaxis.
• Clinical diagnosis remains paramount even with non-specific tryptase findings.

Implications:

• Patients experiencing any symptoms suggestive of anaphylaxis to alteplase should have further infusion immediately stopped.
• Allergen testing may be beneficial for patients with severe reactions to alteplase.
• Awareness of anaphylaxis as an adverse event is important for clinicians managing acute ischemic stroke.