It has been demonstrated that certain patients are more prone to ATRs, suggesting that certain donor factors play a role. Like TRALI, it has been suggested that ATRs are most likely to be a two-hit mechanism in which the recipient becomes primed or sensitized before transfusion.
Except for the prophylactic use of IgA-deficient donors and plasma reduction for recipients with high-titer class-specific anti-IgA, prevention of ATRs has been limited to pretreatment with antihistamines or steroids. Fortunately, except for anti-IgA-related anaphylaxis, most allergic reactions are mild and do not have serious clinical sequelae. However, they result in significant discomfort, cost (for serologic workups), and product wastage.
