Kraske G K, Shinaberger J H, Klaustermeyer W B
Allergy and Immunology-111R Section-111L, West Los Angeles V A Medical Center, California, USA.
Ann Allergy Asthma Immunol. 1997 Feb;78(2):217-20. doi: 10.1016/s1081-1206(10)63390-x.
Hemodialysis-associated hypersensitivity reactions are well documented in the literature. Ethylene oxide sensitization and activation of complement are important factors involved during such reactions. The majority of severe hypersensitivity reactions in dialysis patients, however, is due to sensitization to ethylene oxide.
We report a patient admitted to the hospital with worsening of his renal function. He subsequently required three hemodialysis treatments, all of which resulted in severe hypersensitivity reactions requiring endotracheal intubation. The initial hypersensitivity episode was thought to be due to complement activation to the cupramonium-rayon membrane dialyzer. Despite changing to a polyacrylonitrile membrane, which does not activate complement, a second hypersensitivity reaction developed. Suspecting ethylene oxide hypersensitivity, the third hemodialysis session incorporated a biocompatible dialyzer that was sterilized with gamma irradiation, not ethylene oxide. Yet again, an anaphylactoid reaction resulted. It was postulated that residual ethylene oxide in the tubing might have triggered this last attack.
Despite a negative RAST (radioallergosorbent test) to ethylene oxide, the strong history surrounding each of the hypersensitivity episodes and high index of suspicion pointed to ethylene oxide hypersensitivity as the etiologic factor. To this end, the patient fared much better when peritoneal dialysis was initiated. The patient subsequently died from other complications of his illness.
This case report demonstrates both the complex nature involving a hypersensitivity reaction to hemodialysis and the life-threatening severity of such a reaction. Replacing ethylene oxide with steam or gamma radiation to sterilize dialyzers and thoroughly rinsing new dialyzers and tubing with normal saline may help circumvent this problem.
血液透析相关的过敏反应在文献中有充分记载。环氧乙烷致敏和补体激活是此类反应中的重要因素。然而，透析患者中大多数严重过敏反应是由于对环氧乙烷致敏所致。
我们报告一名因肾功能恶化入院的患者。他随后需要进行三次血液透析治疗，所有治疗均导致严重过敏反应，需要进行气管插管。最初的过敏反应被认为是由于对铜氨人造丝膜透析器的补体激活所致。尽管更换为不激活补体的聚丙烯腈膜，但仍发生了第二次过敏反应。怀疑是环氧乙烷过敏，第三次血液透析使用了经伽马射线辐照灭菌而非环氧乙烷灭菌的生物相容性透析器。然而，再次出现了类过敏反应。据推测，管路中残留的环氧乙烷可能引发了最后一次发作。
尽管对环氧乙烷的放射性变应原吸附试验（RAST）结果为阴性，但每次过敏反应的强烈病史和高度怀疑指向环氧乙烷过敏是病因。为此，开始进行腹膜透析后患者情况好转。患者随后死于疾病的其他并发症。
本病例报告既证明了血液透析过敏反应的复杂性，也证明了此类反应危及生命的严重性。用蒸汽或伽马射线代替环氧乙烷对透析器进行灭菌，并使用生理盐水彻底冲洗新的透析器和管路，可能有助于避免这个问题。
