Incidence, pathomechanism and prevention of dextran-induced anaphylactoid / anaphylactic reactions in man

The symptoms of dextran-induced anaphylactoid/anaphylactic reactions (DIAR) range from skin reactions to severe circulatory shock (severity grades I-IV). The reported incidence of DIAR varies between 0.03% and 4.7%, severe reactions comprising 0.008% and 0.6% resp. Studies to elucidate the pathomechanism of DIAR and to possibly prevent them were made during the last decade: No evidence for a pathogenic role of contaminating macromolecules was found, but the dextran molecule itself could be incriminated as elicitor agent. High titres of dextran reactive antibodies (DRA) of predominantly IgG class are regularly found in sera of patients with grade III+IV reactions. Such DRA reflect immunization with dextran cross-reactive bacterial polysaccharides or native dextran. No DRA of IgE class were found. Presence of high IgG-DRA levels, reduction of complement factor Clq and histopathological findings in lungs, all indicate that DIAR should be classified as aggregate (immune complex) anaphylaxis. Hapten inhibition was therefore proposed to prevent DIAR. Based on positive results in animal models, clinical trials were started 1978. Hitherto, 60 485 patients have been studied. It is concluded that the combined use of preinjection of 20 ml Dextran 1 (Pharmacia AB, Uppsala, Sweden) and infusion of Macrodex or Rheomacrodex improves the safety of dextran administration.