Anaphylactoid reaction to pentastarch

To report a probable anaphylactoid reaction to pentastarch, a low molecular weight hydroxyethyl starch (HES) colloid solution.

Following a closed head injury, an 18-yr-old male was admitted to the Intensive Care Unit. Therapy was directed towards control of intracranial pressure (ICP) and maintenance of cerebral perfusion pressure (CPP). In the first 12 hr after admission, he had received 2500 ml polygeline (Haemaccel, Hoechst Marion Roussel Ltd.) and a dopamine infusion (up to 10 micrograms.kg-1.min-1) titrated to achieve a mean arterial pressure (MAP) of > or = 80 mmHg. Subsequent failure to achieve the target MAP resulted in commencement of a noradrenaline infusion (2.67 micrograms.min-1), and rapid administration of 500 ml pentastarch (Pentaspan, DuPont Pharmaceuticals). During the HES infusion, marked hypotension (MAP < 60 mmHg) developed associated with marked truncal urticaria. The hypotension was resistant to escalation of noradrenaline to 36 micrograms.min-1. Haemodynamic stability was rapidly restored and maintained with adrenaline boluses (total 450 micrograms) and infusion (1.67 micrograms.min-1). The remainder of the patient's ICU and hospital stay was unremarkable. A serum tryptase drawn in the first 40 min of the reaction was not elevated. Other biochemical markers were not assayed. Skin testing has not been carried out.

The temporal relationship and clinical manifestations observed in this case, together with the resistance to inotropes/vasopressors other than adrenaline is highly suggestive of an anaphylactoid reaction to pentastarch. The diagnostic value of serum tryptase may be compromised when blood samples are drawn too early.