Hypersensitivity reactions in patients receiving hemodialysis

Publication date: Available online 26 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Lavjay Butani, Gianfranco Calogiuri
ObjectiveTo describe hypersensitivity reactions in patients receiving maintenance hemodialysis.Data SourcesPubMed search of articles published during the past 30 years with an emphasis on publications in the past decade.Study SelectionsCase reports and review articles describing hypersensitivity reactions in the context of hemodialysis.ResultsPharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients.ConclusionAlthough hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population.



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