Hypersensitivity Reactions to Fibrin Glue During Epidural Blood Patching

BACKGROUND AND PURPOSE: Fibrin glue is increasingly incorporated as a component in epidural blood patching (EBP) for the treatment of spinal CSF leaks. Hypersensitivity reactions are a potential complication of its use but are not well studied in the setting of EBP. The purpose of this study was to determine the incidence of hypersensitivity reactions to fibrin glue during EBP and to identify any predisposing factors associated with increased patient risk.

MATERIALS AND METHODS: A single-center retrospective cohort study with nested case-control design included patients who received fibrin glue EBP for the treatment of iatrogenic CSF leaks or spontaneous intracranial hypotension over 13 years. Patient demographics and multiple procedure-specific variables were collected. Cases were identified from the total cohort as those with hypersensitive reactions and matched with controls in a 1:3 ratio. The incidence of hypersensitivity reactions in the total cohort was calculated. Logistic regression models were fit to test for associations between variables and the development of a hypersensitivity reaction.

RESULTS: A total of 3065 CT-guided EBPs with fibrin glue were identified in 1574 individual patients. The incidence of hypersensitivity reactions was 0.49% per procedure and 0.95% per patient and never occurred during the first EBP with fibrin glue. Case-control analysis found higher odds for hypersensitivity reactions in patients with a lower BMI (OR 0.82 [0.71–0.96], P = .003), younger age (OR 0.95 [0.91–0.99], P = .011), and during procedures with inadvertent intravenous injections (OR 5.44 [1.34–22.01], P = .014).

CONCLUSIONS: We found a 0.49% incidence of hypersensitivity reactions during EBP with fibrin glue, none occurring during the first exposure. Younger age, lower BMI, and inadvertent intravenous injection during the procedure were associated with a higher likelihood of reactions. This study provides data useful for counseling patients on procedural risk and identifies variables for physicians to be aware of to help prevent life-threatening reactions to fibrin glue during EBP.