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Severe hypersensitivity reaction during hemodialysis
G K Kraske1, J H Shinaberger, W B Klaustermeyer
1Allergy and Immunology-111R Section-111L, West Los Angeles V A Medical Center, California, USA.
Summary
Severe hypersensitivity reactions during hemodialysis can be life-threatening. Ethylene oxide sterilization of dialysis equipment is a common cause, even with alternative membranes and sterilization methods.
Area of Science:
- Nephrology
- Allergy and Immunology
Background:
- Hemodialysis-associated hypersensitivity reactions are a known clinical challenge.
- Ethylene oxide sensitization and complement activation are key implicated factors.
Observation:
- A patient experienced severe hypersensitivity reactions during three hemodialysis treatments requiring intubation.
- Reactions persisted despite switching to a non-complement activating membrane and a gamma-sterilized dialyzer.
Findings:
- Despite a negative radioallergosorbent test (RAST) for ethylene oxide, clinical suspicion strongly indicated it as the cause.
- The patient improved significantly with peritoneal dialysis, suggesting hemodialysis-related hypersensitivity.
Implications:
- This case highlights the complex and severe nature of hemodialysis hypersensitivity.
- Alternative sterilization methods like steam or gamma radiation and thorough rinsing of equipment are recommended to prevent ethylene oxide exposure.