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Anaphylactoid reactions due to hydroxyethyl starch infusion
Summary
Hydroxyethyl starch (HES) infusions can cause rare incompatibility reactions, including anaphylaxis. While specific antibodies weren't found, immediate skin tests confirmed reactions in some patients.
Area of Science:
- Anesthesiology
- Pharmacology
- Immunology
Background:
- Hydroxyethyl starch (HES) is a colloid solution used for volume replacement.
- Adverse reactions to HES, though uncommon, require careful monitoring and understanding.
Purpose of the Study:
- To investigate the incidence and clinical presentation of incompatibility reactions associated with 6% HES (Plasmasteril) administration.
- To explore potential immunological mechanisms underlying these HES-induced reactions.
Main Methods:
- Observational study of 10,273 infusions of 500 ml 6% HES (Plasmasteril).
- Clinical assessment of incompatibility reactions, including symptoms and severity.
- Analysis of serum immunoglobulin concentrations (Ig) and specific antibodies.
- Intradermal skin testing with HES dilutions in affected patients.
Main Results:
- Eight incompatibility reactions (0.078%) were observed during HES infusions.
- Clinical symptoms varied from skin reactions to severe hypotension and shock.
- Reduced serum immunoglobulin concentrations were noted in 3/8 patients post-reaction.
- No specific antibodies against HES were detected, and IgE levels remained normal.
- Five patients showed positive immediate-type reactions to intradermal HES skin tests.
Conclusions:
- Incompatibility reactions to HES (Plasmasteril) can occur, presenting with diverse clinical symptoms.
- The underlying mechanism may involve non-antibody-mediated hypersensitivity, as indicated by negative specific antibody tests but positive skin reactions.