Allergy Asthma Respir Dis.  2014 Mar;2(1):78-81. 10.4168/aard.2014.2.1.78.

Anaphylaxis induced by lysozyme in Green cough

• Youn TY
• Kim MK

• KMID: 2168576
• DOI: http://doi.org/10.4168/aard.2014.2.1.78

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.

Keyword

Drug allergy; Anaphylaxis; Lysozyme; Tryptase

MeSH Terms

Adult
Amino Acids
Anaphylaxis*
Angioedema
Cough*
Drug Hypersensitivity
Dyspnea
Emergency Service, Hospital
Female
Gastric Juice
Humans
Immunoenzyme Techniques
Molecular Weight
Muramidase*
Saliva
Skin
Tryptases
Urticaria
Amino Acids
Muramidase
Tryptases

Figure

• 

  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.

Reference

1. Fremont S, Kanny G, Nicolas JP, Moneret-Vautrin DA. Prevalence of lysozyme sensitization in an egg-allergic population. Allergy. 1997; 52:224–228.

2. Cheetham JC, Artymiuk PJ, Phillips DC. Refinement of an enzyme complex with inhibitor bound at partial occupancy Hen egg-white lysozyme and tri-N-acetylchitotriose at 1.75 A resolution. J Mol Biol. 1992; 224:613–628.

3. Mine Y, Yang M. Recent advances in the understanding of egg allergens: basic, industrial, and clinical perspectives. J Agric Food Chem. 2008; 56:4874–4900.

4. Jacobsen B, Hoffmann-Sommergruber K, Have TT, Foss N, Briza P, Oberhuber C, et al. The panel of egg allergens, Gal d 1-Gal d 5: Their improved purification and characterization. Mol Nutr Food Res. 2008; 52:Suppl 2. S176–S185.

5. Weber P, Kratzin H, Brockow K, Ring J, Steinhart H, Paschke A. Lysozyme in wine: a risk evaluation for consumers allergic to hen's egg. Mol Nutr Food Res. 2009; 53:1469–1477.

6. Iaconelli A, Fiorentini L, Bruschi S, Rossi F, Mingrone G, Piva G. Absence of allergic reactions to egg white lysozyme additive in Grana Padano cheese. J Am Coll Nutr. 2008; 27:326–331.

7. Pérez-Calderón R, Gonzalo-Garijo MA, Lamilla-Yerga A, Mangas-Santos R, Moreno-Gaston I. Recurrent angioedema due to lysozyme allergy. J Investig Allergol Clin Immunol. 2007; 17:264–266.

8. Kim SM, Kim KS, Kim MK. A case of anaphylaxis to trimethoprim-sulfamethoxazole. Korean J Med. 2011; 80:365–369.

9. Kim JJ, Park JK, Kim MK. 24kD protein in Korean Ginseng, PRP-5 is a new allergen in Oral allergy syndrome [abstract]. In : Programm and abstrat, the 59th Annual Spring Meeting of the Korean Asthma and Allergy Society; 2009 May 16; Seoul, Korea. Seoul: Korean Asthma and Allergy Society;2009. 29:p. 118.

10. Kumita JR, Helmfors L, Williams J, Luheshi LM, Menzer L, Dumoulin M, et al. Disease-related amyloidogenic variants of human lysozyme trigger the unfolded protein response and disturb eye development in Drosophila melanogaster. FASEB J. 2012; 26:192–202.

11. Cho YS, Yoon TY, Choi W, Kim KS, Kim MK. A case of anaphylaxis induced by polysorbate 80 in parenteral multivitamin. Korean J Asthma Allergy Clin Immunol. 2009; 29:204–207.