Plasma serotonin and histamine levels in hemodialysis-related pruritus are not significantly influenced by 5-HT3 receptor blocker and antihistaminic therapy.
BACKGROUND
Elevated plasma histamine levels are considered to play a part in the pathophysiology of hemodialysis-related pruritus. However, antihistaminic therapy often fails to provide sufficient relief. Elevated serotonin levels in patients on dialysis therapy have also been described but the effects of 5-HT3 receptor antagonists on hemodialysis-related pruritus remain controversial.


METHODS
we conducted a study to determine plasma histamine and serotonin levels before and after treatment with 5-HT3 receptor antagonists (tropisetron 5 mg and ondansetron 8 mg) and an antihistamine (cetirizine 10 mg). Eleven hemodialysis patients with a history of pruritus participated in this study,10 healthy volunteers served as control group.


RESULTS
Histamine and serotonin values were normal in patients and controls. Treatment with cetirizine did not significantly reduce histamine levels in patients or in controls. Tropisetron and ondansetron likewise did not alter serotonin levels in patients. Tropisetron treatment did not significantly change serotonin levels in controls.


CONCLUSIONS
Histamine and serotonin are no major mediators of pruritus in hemodialysis patients. Elevated histamine levels are occassionally seen and may be due to the increased mast cell number found in a subgroup of hemodialysis patients. Our findings explain the only marginal relief of antihistamines and the controversial antipruritic effect of serotonin receptor antagonists in hemodialysis-related pruritus.
Weisshaar
E
E
Department of Dermatology, Venereology, Otto von Guericke University, Magdeburg, Germany. elke.Weisshaar@med.uni-heidelberg.de
Dunker
N
N
Domröse
U
U
Neumann
K H
KH
Gollnick
H
H
D000328:Adult; D017332:Cetirizine / Q000627:therapeutic use*; D005260:Female; D006632:Histamine / Q000097:blood*; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D011537:Pruritus / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects; D051437:Renal Insufficiency / Q000628:therapy; D012701:Serotonin / Q000097:blood*; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D016896:Treatment Outcome; D000077526:Tropisetron
D039563:Histamine H1 Antagonists, Non-Sedating; D007211:Indoles; D012702:Serotonin Antagonists; D012701:Serotonin; D017294:Ondansetron; D000077526:Tropisetron; D006632:Histamine; D017332:Cetirizine