Intraoperative anaphylaxis due to aprotinin after local application of fibrin sealant diagnosed by skin tests and basophil activation tests: a case report

JA Clinical Reports

Table 1 Results of skin tests

Skin prick test						Intradermal test
Drug	Concentration of the stock solution (mg/mL)	Judgment	Wheal (mm)	Flare (mm)	Concentration of the stock solution (mg/mL)	Judgment	Wheal (mm)	Flare (mm)
Saline	9	−			9	−
Histamine	10	+	5	10	0.01	+	9	20
Propofol	10	−			1	−
Rocuronium	10	−			0.1	−
Remifentanil	0.05	−			0.005	−
Fentanyl	0.05	−			0.005	−
Cefazolin	20	−			2	−
Flurbiprofen	10	−			1	−
Lidocaine	10	−			1	−
Ropivacaine	2	−			0.2	−
Felt	NA	−			NA	ND
Vial no. 1	80	−			8	−
Vial no. 2	0.17	+	5	6	0.017	+	7	12
Vial no. 3	250^a	−			25^a	−

^aUnits/mL
SPT skin prick test, IDT intradermal test, NA not applicable, ND no data
Saline and histamine were used as negative and positive controls, respectively. SPT was started with a 100-fold dilution of stock solution, and a tenfold dilution and stock solution were inspected. The SPTs for the felt were performed by puncturing a bifurcated needle from above the felt. Histamine and vial no. 2 showed a positive result at the stock solution. Subsequently, IDTs were performed. After confirming a negative reaction for saline and a positive reaction for histamine, vial no. 2 showed a positive reaction at a 100-fold dilution of the stock solution, that is, 0.00017 mg/ml. Other tested agents did not result in a positive reaction with a 100-fold dilution of the stock solution. SPT reactions were deemed positive when the diameter of the wheal was equal to or 3 mm larger than in the negative control, or equal to at least half that in the positive control after 20 min. IDT reactions were deemed positive when the diameter of the wheal was equal to at least twice that of the post-injection wheal after 20 min [6]