Recurrent intradialytic heparin induced anaphylaxis: workup and management

Santosa, Amelia; Tan, Seng Hoe; Cheng, Yuan

doi:10.5415/apallergy.2013.3.4.285

Cited by 4 publications

(1 citation statement)

References 13 publications

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“…Various mechanisms (Figure 3) have been proposed for allergic and allergic-like reactions during HD depending on the allergen (77,(82)(83)(84)(85)(86)(87)(88). Ethylene oxide mediates anaphylaxis through IgE-mediated hypersensitivity, whereas dialyzer components typically activate complement or bradykinin.…”

Section: Allergic Reaction During Hdmentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

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Section: Allergic Reaction During Hdmentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs

Macy

2015

Curr Allergy Asthma Rep

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Immediate hypersensitivity reactions to medications are among the most feared adverse drug reactions, because of their close association with anaphylaxis. This review discusses a practical management approach for patients with a history of an immediate hypersensitivity to a non-beta-lactam medication, where reexposure to the implicated, or similar, medication is clinically necessary. Mechanisms associated with severe immediate hypersensitivity reactions include IgE-mediated mast cell activation, complement-mediated mast cell activation, and direct mast cell activation. Immediate hypersensitivity reactions may also be mediated by vasodilators, other pharmacologic mechanisms, or be secondary to underlying patient-specific biochemical abnormalities such as endocrine tumors or chronic spontaneous urticaria. The key features in the reaction history and the biochemistry of the implicated medication are discussed. Most individuals with a history of immediate hypersensitivity to a medication, who require reuse of that drug, can be safely retreated with a therapeutic course of the implicated drug after a full-dose challenge, graded challenge, or desensitization, with or without premedication and/or any preliminary diagnostic testing, depending on the specific situation.

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Heparin

2014

Reactions Weekly

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Recurrent intradialytic heparin induced anaphylaxis: workup and management

Cited by 4 publications

References 13 publications

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs

Heparin

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