SK and allergic reaction

Q: 44-year-old male developed an allergic reaction during Streptokinase (SK) infusion for massive pulmonary embolism with fever, shivering, and generalized rash. In this patient, the clinical efficacy of SK and thrombolytic therapy is reduced?

A) Yes
B) No

Answer: No

Few major takeaway points to remember if SK has been chosen for thrombolytic therapy

• Major allergic reaction due to SK infusion particularly the first time is a rare event, although mild pyrexia and shivering may occur.
• Mere hypotension during SK infusion without any other sign of allergic reaction is not considered a reaction. It may be just a histaminoid event and can be handled with slowing of the infusion, intravenous fluids (IVF) bolus, or transient pressor support. 
• The efficacy of SK as a thrombolytic therapy is not decreased if an allergic reaction occurs.  
• If an allergic reaction occurs after SK infusion, patient stays at risk for an allergic reaction for about 7-8 years

#pulmonary
#pharmacology
#immunology


References:

1. Tsang TS, Califf RM, Stebbins AL, et al. Incidence and impact on outcome of streptokinase allergy in the GUSTO-I trial. Global Utilization of Streptokinase and t-PA in Occluded Coronary Arteries. Am J Cardiol 1997; 79:1232. 

2. Squire IB, Lawley W, Fletcher S, et al. Humoral and cellular immune responses up to 7.5 years after administration of streptokinase for acute myocardial infarction. Eur Heart J 1999; 20:1245.