Increased Plasma Histamine Levels in Uraemic Pruritus

Abstract

1. We determined plasma levels of histamine in uraemic patients and examined their correlation with the presence of pruritus. 2. In 27 patients with chronic renal failure, plasma histamine levels were analysed by radioimmunoassay and were compared with those of 40 healthy adult subjects. The control population showed plasma histamine concentrations of 185 +/- 33 pg/ml, which were significantly lower than those of the patients with renal insufficiency. The highest levels (552 +/- 116 pg of histamine/ml) were found in 16 patients with chronic renal failure (mean serum creatinine 5.1 +/- 1.0 mg/dl) and severe itching. 3. Twelve patients with pronounced pruritus who were on maintenance haemodialysis (serum creatinine 9.2 +/- 1.2 mg/dl) had a mean plasma histamine concentration of 515 +/- 81 pg/ml. Fifteen patients on regular haemodialysis (serum creatinine 9.0 +/- 1.5 mg/dl) and who experienced itching had plasma histamine levels (322 +/- 40 pg/ml) which were significantly lower (P less than 0.01) than those of the patients with pruritus but which were elevated compared with those of the control population (P less than 0.01). 4. No correlation could be found between increased plasma histamine levels and the type of dialysis membrane used or the method of sterilization of the membrane. 5. Haemodialysis alone did not reduce plasma histamine concentrations, although high concentrations could be detected in the ultrafiltrate. In six patients a rapid decrease in plasma histamine concentration from 565 +/- 134 pg/ml to within the normal range could be detected after 60 min of combined haemodialysis and haemoperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Histamine and Serotonin in Uremic Pruritus: Effect of Ondansetron in CAPD-Pruritic Patients

“…Some investigators have found a positive correlation between plasma histamine levels and pruritus [7, 8, 11, 15, 16], but this has not been confirmed by others [5, 30]. In our study, the plasma histamine levels of patients with pruritus were higher than those of nonpruritic patients, but the difference was not statistically significant (p = 0.06).…”

“…It was reported that plasma histamine levels were increased in uremic patients, mainly in those with pruritus [5, 7, 8, 11, 15, 16, 29, 30]. Some investigators have found a positive correlation between plasma histamine levels and pruritus [7, 8, 11, 15, 16], but this has not been confirmed by others [5, 30].…”

“…Histamine and serotonin have been reported as possible mediators of uremic pruritus [5, 7, 8, 9], although treatment with H 1 antihistamines is efficacious only in some cases [9, 10]. Because the cause is unknown, many therapeutic approaches, most of them empirical, have been used, but most are helpful only in a few patients [10, 11, 12, 13, 14].…”

“…Plasma histamine levels were found to be increased in uremic patients, mainly in those with pruritus [5, 7, 8, 11, 15, 16], and some investigators have found a positive correlation between plasma histamine levels and pruritus [7, 8, 11, 15, 16], but this was not confirmed by others [5]. Serotonin has been reported to be a mediator of uremic pruritus – it causes itching when injected with prostaglandins –, and the results with the use of ketotifen, a stabilizer of mast cell membrane, in patients with uremic pruritus are encouraging [15, 16].…”

Response of patients with hemodialysis-associated pruritus to new treatment algorithm with nalfurafine hydrochloride: a retrospective survey-based study

“…The complex interplay Fig. 4 Changes in drugs used for pruritus treatment in patients managed at our facility of these multiple factors in hemodialysis patients can result in pruritus that often fails to respond sufficiently to existing treatments, including antihistamines, antiallergy drugs, and steroids [10][11][12][13].…”