392 Lung Toxicity Induced by Novel Antineoplastic Therapies in Cancer Patients

comparison with the negative control was scored as positive. Furthermore, in vitro allergy testing using the Phadia CAP system for specific IgE against shrimp, fish-mix, rainbow trout, rCyp p 1 and protamine sulfate was performed. Results: Skin prick tests were positive to shrimp, fish-mix, mackerel, salmon and protamine sulfate. Intradermal testing with protamine showed a wheal diameter of 7 mm. Analysis of a blood sample showed elevated total IgE (2600 kU/L) and specific IgE to shrimp (2.94 kU/L), fish-mix (0.53 kU/L), rainbow trout (0.39 kU/L), rCyp p1 (0.53 kU/L) and protamine sulfate (0.77 kU/L). Conclusions: Protamine sulfate is a polycationic peptide used to reverse the anticoagulant effects of heparin during cardiac surgery. It is commercially produced from the sperm of salmon and it is considered that persons who have an allergy to fish could be at risk of protamine reactions. The exact mechanisms by which it causes anaphylaxis are not fully understood. Due to a clear sensitization to fish proteins and protamine sulfate and a known allergy to shellfish we disapproved the standard anticoagulation protocol with heparin/protamine. Bivalirudin was used as an anticoagulant and the surgery proceeded without any untoward events.