title: Anaphylactic Shock at the Beginning of Hemodialysis.
abstract: In patients who receive hemodialysis, most hypersensitivity reactions to components of the dialysis circuit are due to ethylene oxide or complement activating bio-incompatible membranes. We present a case of a 59 year-old female, with a 4-year history of uneventful hemodialysis using a cellulose based dialyzer membrane at her outpatient dialysis center, who developed repeated anaphylactic reactions associated with markers of an IgE mediated hypersensitivity reaction when a polysulfone based dialyzer membrane was used while she was hospitalized. Only when the patient's dialyzer was changed back to her usual cellulose based membrane, did these reactions cease. On the basis of her clinical course and laboratory findings, we concluded that the patient's symptoms were due to exposure to polysulfone. This case reminds us that "biocompatible" membranes are not free from dialyzer reactions, and can be especially severe if the mechanism is an IgE mediated anaphylactic hypersensitivity reaction.
authors.affiliation: Section of Nephrology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Khaleel
authors.initials: K
authors.lastname: Sayeed
authors.affiliation: Section of Nephrology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Charlene
authors.initials: C
authors.lastname: Murdakes
authors.affiliation: Department of Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Andrej
authors.initials: A
authors.lastname: Spec
authors.affiliation: Section of Nephrology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Casey
authors.initials: C
authors.lastname: Gashti
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008567:Membranes, Artificial; D008875:Middle Aged; D011108:Polymers / Q000009:adverse effects*; D006435:Renal Dialysis / Q000009:adverse effects; D013450:Sulfones / Q000009:adverse effects*
chemical_list: D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700