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Human serum albumin (HSA), a 67-kDa protein, accounts for 60% of the proteins in human plasma. It helps to maintain oncotic pressure and transport hormones and medications. HSA is used as substitution therapy in hypoproteinemia and as a vehicle in some vaccines. Commercial HSA is obtained from human plasma using the Cohn method, with sterilization by pasteurization at about 60°C for 10 hours [1]. The procedure causes albumin to aggregate in polymers, thus creating macromolecules that may be antigenic. A 51-year-old man with no previous history of drug allergy was diagnosed with metastatic colon adenocarcinoma. He was admitted for partial hepatectomy and received 3 platelet concentrates during the surgical intervention. Four days later, he received intravenous human albumin (Grifols SA). Immediately after an infusion of about 20 mL of this solution, he developed palmar and lingual pruritus and generalized erythematous-papular exanthema. Oxygen saturation was 93%, although he did not complain of dyspnea. He was treated with oxygen therapy, corticosteroids, and antihistamines and recovered in about 20 minutes. This was his first treatment with intravenous albumin in our hospital, although the patient had previously been treated in another hospital, where he underwent other surgical procedures (appendectomy and ventral midline hernioplasty). Twelve hours after the reaction, serum tryptase was within normal values (2.61 μg/L). Unfortunately, no blood sample was obtained before that time. Specific IgE to animal albumins (bovine seralbumin, ovalbumin, pig seralbumin, and α-lactalbumin) and skin prick tests (SPTs) with latex, lactalbumin, ovalbumin, and meats (chicken, pork, and veal) all yielded negative results. SPTs and intradermal tests (IDTs) with purified human albumin (Grifols, CLS Behring, and Roxall Group) were positive at a 1/10 dilution for the Grifols and Roxall products and a 1/100 dilution for the Behring product. SPTs and IDTs were subsequently performed with the 3 albumins in 5 healthy controls and yielded negative results. Basophil activation tests (BATs) with pure and 1/10 diluted Manuscript received May 20, 2018; accepted for publication September 13, 2018.

Human Serum Albumin Induced Anaphylaxis in a Patient With Good Tolerance to Human Plasma