title: Hydroxyethyl starch-induced pruritus: clinical characteristics and influence of dose, molecular weight and substitution.
abstract: Severe persistent pruritus is a common, but incompletely characterized, complication of hydroxyethyl starch (HES) infusion. This retrospective study aimed to assess HES-induced pruritus by electron microscopic findings, pruritus characteristics, and response to stimuli, and to determine the impact of HES dosage, molecular weight and substitution. Seventy patients with electron micro-scopy-proven HES-induced pruritus were included. HES-laden vacuoles were observed in skin macrophages of all patients. The median latency between HES exposure and pruritus onset was 3 weeks, and the median duration of pruritus was 6 months. Pruritus was severe, or very severe, in 80% of patients. Mechanical stimuli triggered pruritus in 74% of patients. Although the median cumulative dose of HES was 300 g, 15% of patients developed pruritus after only 30 g. There were no significant differences between HES 130/0.4 and HES 200/0.5 in pruritus latency, duration or severity. HES-induced pruritus thus may occur at any dose, molecular weight or substitution.
authors.affiliation: Department of Dermatology and Competence Center Chronic Pruritus (KCP), University Hospital of Münster, Von-Esmarch-Str. 58, DE-48149 Münster, Germany. sonja.staender@uni-muenster.de.
authors.forename: Sonja
authors.initials: S
authors.lastname: Ständer
authors.forename: Laura
authors.initials: L
authors.lastname: Richter
authors.forename: Nani
authors.initials: N
authors.lastname: Osada
authors.forename: Dieter
authors.initials: D
authors.lastname: Metze
mesh_terms: D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D011537:Pruritus / Q000139:chemically induced* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects* / Q000648:ultrastructure; D013997:Time Factors
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes