Anaphylaxis induced by lysozyme in Green cough

Tae-Young Youn; Mi-Kyeong Kim

doi:10.4168/aard.2014.2.1.78

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Youn and Kim: Anaphylaxis induced by lysozyme in Green cough

Case Report

Allergy, Asthma & Respiratory Disease 2014; 2(1): 78-81.

Published online: 31 March 2014

DOI: https://doi.org/10.4168/aard.2014.2.1.78

Anaphylaxis induced by lysozyme in Green cough

Tae-Young Youn¹, Mi-Kyeong Kim^2,^3,⁴

¹Department of Dermatology, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea.

²Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea.

³Regional Pharmacoviugilence Center, Cheongju, Korea.

⁴Regional Respiratory Disease Center, Cheongju, Korea.

Correspondence to: Mi-Kyeong Kim. Department of Internal Medicine, Chungbuk National University College of Medicine, 776 1(il)sunhwan-ro, Heungdeok-gu, Cheongju 361-7, Korea. Tel: +82-43-269-6355, Fax: +82-43-273-3252, kimmk@chungbuk.ac.kr

Received 23 May 2013 Revised 15 July 2013 Accepted 22 July 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Lysozyme is a small protein composed of 129 amino acids with a molecular weight of 14.3 kD. In human, it is in the eye drop, saliva, nasal secretion, and gastric juice. Because of its bactericidal properties, this protein is used as an additive in various food and drug products. A 34-year-old female patient had visited at emergency room for generalized urticaria, angioedema, and dyspnea a few minutes after taking Green cough capsule which contains lysozyme. Her serum tryptase level measured by florescence enzyme immunoassay was 11 mg/mL. Skin prick tests with Green cough itself, and then with its 10 ingredients including lysozyme chloride showed strong positive reaction to Green cough and lysozyme chloride. Base on her symptoms and the results obtained from high level of serum trypase and skin prick tests, we have concluded her conditions to be an anaphylaxis induced by lysozyme.

Keywords: Drug allergy, Anaphylaxis, Lysozyme, Tryptase

Figures and Tables

Fig. 1

Results of skin prick tests with Green cough and its 10 ingredients including lysozyme.

Fig. 2

Results of serum specific immunoglobulin E (IgE) antibody to lysozyme-human serum albumin (HSA) conjugate measured by enzyme-linked immunosorbent assay in patient and 15 unexposed controls. Optic density of this patient was 0.56 which was more than 3 times higher than the mean value of controls.

Fig. 3

Results of Western blotting of lysozyme. Immunoglobulin E binding with 14 kD protein was detected. MW, indicator of molecular weight.

Table 1

Results of skin prick tests with Green cough and its ingredients

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