Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
Hypersensitivity reactions to streptokinase in patients with high pre-treatment antistreptokinase antibody and neutralisation titres
*Department of Cardiology, Aberdeen Royal Infirmary Aberdeen, Scotland, U.K.
Department of Microbiology, Aberdeen Royal Infirmary Aberdeen, Scotland, U.K.
Department of Haematology, Aberdeen Royal Infirmary Aberdeen, Scotland, U.K.
Received 5 March 1993; revised 6 July 1993; .
Correspondence Dr Hai Shiang Lee. Department of Cardiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB, Scotland. U.K.
Abstract
After streptokinase or antistreplase administration, raised antibody levels can persist for many years, but it is unclear if these antibodies can cause allergic reactions following streptokinase re-administration for myocardial re-infarction. Pre-treatment antistreptokinase antibody (AB) and neutralisation litres (NT) were measured in 189 consecutive patients (57 received streptokinase or anistreplase). Seven patients had previous exposure to streptokinase or anistreplase; they had high mean (SEM) antibody litres of 1:801 (332) and neutralisation litres of 3.3 (1.7) million units. The 182 patients without previous thrombolysis had mean (SD) antibody titres of 1:25 (3) and neutralisation litres of 0.14 (0.08) million units; nine patients (4.95%), however, had raised antibody litres of 
1:160 and neutralisation litres of 0.3 million units. Of the 15 patients with antibody litres of 1:160, three received streptokinase or anistreplase. Hypersensitivity reactions occurred in all three patients — neutralisation litres 0.48, 1.5 and 1.1 million units respectively. Two became severely hypotensive with systolic pressures of 70 mmHg; one developed a serum sickness-like reaction. Importantly, none of the 54 patients with antibody titres of < 1:160 who received streptokinase or antistreplase reacted adversely to the thrombolytic agents (
2 with Yates 's correction = 38.71 , P<0.01). High antibody titres are associated with hypersensitivity reactions to streptokinase. This has important implications in reinfarction thrombolysis. In patients whose antistreptokinase antibody titres are likely to be raised the avoidance of streptokinase-related thrombolytic agents should be considered.
Key Words: Antibodies • coronary disease • myocardial infarction • thrombolytic therapy • hypersensitivity
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