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.
Bommer
J
J
Wilhelms
O H
OH
Barth
H P
HP
Schindele
H
H
Ritz
E
E
D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced*; D000917:Antibody Formation; D001491:Basophils / Q000201:enzymology / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology; D005027:Ethylene Oxide / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000378:metabolism; D010561:Personnel Staffing and Scheduling; D006435:Renal Dialysis / Q000009:adverse effects*; D013242:Sterilization / Q000379:methods; D014511:Uremia / Q000276:immunology
D007073:Immunoglobulin E; D010447:Peptide Hydrolases; D005027:Ethylene Oxide