Prior Vasectomy and Anaphylaxis Following Protamine: No Cause and Effect

Abstract

Adourian et al. in a case report identify a patient with a previous vasectomy antiprotamine IgG antibodies and 2 hypotensive episodes after receiving protamine. In presenting the case the authors imply that the patient suffered 2 anaphylactic reactions to protamine that IgG antibodies to protamine were a response to prior vasectomy. This author however argues that the case report does not support these implications and that any association among these observations remains speculative. He takes issue with the authors contentions that both reactions to protamine were anaphylactic and that IgG antibodies to protamine produce severe reactions to protamine. Furthermore although the patient could have produced antiprotamine antibodies during his vasectomy and from his exposure to intravenous protamine during catheterization the authors do not state why the vasectomy is to blame. Current evidence including the Adourian case is simply inadequate to implicate prior vasectomy as a risk factor for severe reactions to protamine.