Allergy to protamine sulfate

Adverse responses to protamine sulfate have been identified for many years. The antigen-antibody response to protamine sulfate results in a type I anaphylactic reaction. Manifestations of allergic reactions include hypotension, bronchospasm, and skin and mucous membrane reactions. The severity of the adverse responses may vary from mild to causing death. Several potential risk factors for adverse reactions to protamine have been identified, including insulin-dependent diabetes mellitus, vasectomy, allergy to fish, prior exposure to protamine sulfate, and the rate of infusion. A case study is presented, and strategies for improving patient outcomes are discussed. (Heart Lung® 1999;28:418-28)