Anaphylactoid reactions to plasma substitutes.

Area of Science:

• Anesthesiology
• Immunology
• Pharmacology

Background:

• Anaphylactoid reactions are a known complication of plasma substitutes.
• These reactions present with a spectrum of severity, from mild skin reactions to life-threatening events.
• The underlying mechanisms differ among various colloid types.

Purpose of the Study:

• To review the mechanisms and management of anaphylactoid reactions to plasma substitutes.
• To discuss diagnostic approaches and preventive strategies.
• To outline treatment guidelines based on reaction severity.

Main Methods:

• Literature review of anaphylactoid reactions associated with plasma substitutes.
• Analysis of pathomechanisms for dextran, gelatin, and hydroxyethyl starch (HES).
• Evaluation of diagnostic tests, preventive measures, and treatment protocols.

Main Results:

• Dextran reactions may involve anti-dextran antibodies (IgG), with limited value of skin tests. Pre-administration of low-molecular-weight dextran can reduce reactions.
• Gelatin reactions are primarily mediated by histamine; purification and H1/H2 antagonists reduce frequency.
• HES reactions involve complement changes; antibodies exist but don't correlate with reactions. HES can cause irreversible storage.
• Treatment depends on severity; epinephrine for grades III/IV, early glucocorticosteroids are beneficial.

Conclusions:

• Anaphylactoid reactions to plasma substitutes require understanding of specific colloid mechanisms.
• Preventive strategies and appropriate treatment based on severity are crucial.
• Further research into safer plasma substitutes and reaction mitigation is warranted.