Urticaria from allergy to a purified human anti‐Rh antibody preparation

RhD immunoglobulin G (anti-D) administered to pregnant Rh(-) women prevents Rh isoimmunization. Its use has significantly reduced the incidence of haemolytic disease of the foetus and newborn previously responsible for one death in every 2200 births. In pregnancy, acute drug-induced hypersensitivity reactions including anaphylaxis can have serious deleterious effects on the mother and foetus/neonate. Women can be erroneously labelled as drug allergic as the investigation of hypersensitivity reactions in pregnancy is complex and drug challenges are usually contraindicated. We present three cases of suspected anti-D hypersensitivity clinically presenting as anaphylaxis and delayed transfusion-related reaction. We also propose a new algorithm for the investigations of such reaction. It relies on detailed history, cautious interpretation of skin tests, foetal Rh genotyping from maternal blood and, in some cases, anti-D challenges. This is not to deprive women of anti-D which might put their future pregnancies at risk.

show abstract

“…SPT was positive (IDT and DCT not undertaken). In an experimental assay, sIgE to an antigenic contaminant but not anti‐D itself was detected .…”

Section: Discussionmentioning

confidence: 96%

“…Complement and/or mast cell activation may be implicated. Patients with IgA deficiency develop IgE against IgA increasing the risk of hypersensitivity to blood‐derived products .…”

Section: Discussionmentioning

confidence: 99%

Management of hypersensitivity reactions to anti-D immunoglobulin preparations

Rutkowski

Nasser

2014

Allergy

View full text Add to dashboard Cite

show abstract

“…Hypersensitivity adverse reactions, including features of anaphylaxis, have occasionally been reported after administration of anti-D immunoglobulin in pregnant women. In an experimental assay, specific IgE to an antigenic contaminant, but not anti-D itself, was detected [ 106 , 107 ].…”

Section: Biomarkersmentioning

confidence: 99%

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Simionescu

Stănescu

Popescu

2021

Life

View full text Add to dashboard Cite

Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.

show abstract