title: Clinical and pathophysiological aspects of hydroxyethyl starch-induced pruritus: evaluation of 96 cases.
abstract: BACKGROUND
  It has been recently recognized that long-term infusions of hydroxyethyl starch (HES) as a substitute of human plasma may lead to deposits within the human skin and clinically induces severe pruritus in approximately one-third of the patients treated.
  
  
  OBJECTIVE
  To analyze the clinical features and pathophysiology of HES-induced itching.
  
  
  METHODS
  Clinical data of 86 patients were analyzed retrospectively. Furthermore, 10 patients were followed prospectively, in whom we also performed routine laboratory tests, skin biopsies, allergological investigations (skin prick, basophil degranulation test), and substance P measurements in stimulated macrophages.
  
  
  RESULTS
  Special features of HES-induced pruritus included long latency of onset and persistence. Noteworthy, itching is not always generalized. 30% of patients present with localized pruritus. Symptoms were not relieved by antihistaminics. Accordingly, the basophil degranulation test after HES exposure was negative. Also, substance P release from macrophages was not increased following HES stimulation. Deposits were found mainly in macrophages and endothelial cells.
  
  
  CONCLUSIONS
  Our findings indicate that pruritus in HES-infused patients is most likely not triggered by pruritogenic mediators. We support data from the recent literature, suggesting a direct stimulation of cutaneous nerves by HES deposits. In patients suffering from long-standing itching it seems important to consider previous HES exposure as a possible cause not only in generalized pruritus but also in localized symptoms.
authors.affiliation: Department of Dermatology, University of Ulm, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Gall
authors.forename: K D
authors.initials: KD
authors.lastname: Schultz
authors.forename: W H
authors.initials: WH
authors.lastname: Boehncke
authors.forename: R
authors.initials: R
authors.lastname: Kaufmann
mesh_terms: D001707:Biopsy, Needle; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D010328:Patch Tests; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D011863:Radioimmunoassay; D012189:Retrospective Studies; D013373:Substance P / Q000032:analysis*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D013373:Substance P