Butani Lavjay, Calogiuri Gianfranco
University of California Davis Medical Center, Sacramento, California.
Civil Hospital "Sacro Cuore" Gallipoli, Lecce, Italy.
Ann Allergy Asthma Immunol. 2017 Jun;118(6):680-684. doi: 10.1016/j.anai.2017.04.006. Epub 2017 Apr 26.
To describe hypersensitivity reactions in patients receiving maintenance hemodialysis.
PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade.
Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis.
Pharmacologic 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.
Although 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.
描述维持性血液透析患者的过敏反应。
对过去30年发表的文章进行PubMed检索，重点关注过去十年的出版物。
描述血液透析背景下过敏反应的病例报告和综述文章。
药物是接受血液透析患者过敏反应最常见的可识别原因。这些药物包括铁、促红细胞生成素和肝素，它们可引起过敏或类过敏反应，以及局部用抗生素和麻醉剂，它们会导致迟发型过敏反应。许多过敏反应是由补体激活和接触系统激活导致的缓激肽增加所触发，尤其是在使用血管紧张素转换酶抑制剂的情况下。有几种替代药物制剂和透析器膜可供使用，因此一旦确定反应的病因，就可以预防复发，而不会影响为患者提供的护理质量。
尽管过敏反应在接受血液透析的患者中并不常见，但可能危及生命。此外，考虑到终末期肾病患者的庞大数量，此类反应的影响巨大。大多数反应是类过敏反应，并非由免疫球蛋白E介导。透析患者潜在接触因素的多样性以及所处环境的复杂性使得确定这些反应的确切原因具有挑战性。需要付出巨大努力来调查过敏反应，以避免在这一高危人群中复发。
