Anaphylactoid reactions in dialysis patients: role of ethylene-oxide

To determine whether anaphylactoid reactions during dialysis are the result of allergy to ethylene oxide (EtO) used for sterilisation of dialysis equipment, EtO-specific cytophilic antibodies on basophils were detected by means of a sensitive protease-release assay. Antibodies were found in 2 of 44 healthy controls, 2 of 16 staff members, 4 of 17 patients with preterminal uraemia, and 35 of 83 dialysis patients. 22 of the dialysis patients with antibodies, but only 9 of those without had anaphylactoid reactions during dialysis. Symptoms were more common in patients with antibodies. Symptoms and antibodies were less in a unit where dialysers were rinsed more thoroughly, and were increased in patients with a history of atopy. EtO antibodies decreased or became undetectable in patients who were dialysed with non-EtO-sterilised equipment for eight weeks, and symptoms improved strikingly. On re-exposure to EtO-sterilised material, symptoms returned and EtO-induced protease release increased. EtO sterilisation of dialysis equipment should be discontinued.