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Why do patients develop reactions to streptokinase?
M Lynch1, B L Pentecost, W A Littler
1Department of Medicine, University of Queensland, Prince Charles Hospital, Chermside, Australia.
Clinical and Experimental Immunology
|November 1, 1993
Summary
Minor reactions to streptokinase are not common and may not be antibody-mediated. Complement activation might play a role, but antibody levels do not predict reactions in patients receiving streptokinase therapy.
Area of Science:
- Immunology
- Pharmacology
Background:
- Minor reactions to streptokinase are frequent but their cause is unknown.
- Previous assumptions linked these reactions to antibody-mediated immune responses.
Purpose of the Study:
- To investigate the immunological basis of minor reactions to streptokinase.
- To determine if antibody titers or complement activation predict these reactions.
Main Methods:
- Measured specific anti-streptokinase IgG subclasses (IgG1-4) and IgE in reacting patients using ELISAs, haemagglutination, and immunoblotting.
- Assessed complement activation via hemolytic assays and C3/C4/C3d levels.
- Analyzed streptokinase preparations for antigenic contaminants like human albumin.
Main Results:
- Patients showed low anti-streptokinase IgG and IgG1 titers; no specific IgE or other IgG subclasses were detected.
- Anti-streptokinase IgG1 was found to fix complement, and reacting patients had low total complement levels post-reaction.
- Antigenic albumin fragments were present in the drug but not linked to reactions.
Conclusions:
- Low antibody titers do not predict streptokinase reactions.
- Minor reactions to streptokinase may not be directly antibody-mediated, but complement activation could be involved.
- Further research is needed to elucidate the exact mechanisms behind streptokinase reactions.