Plasma substitutes anaphylactoid reactions

The most important adverse effect results from the antigenicity of dextrans, which may lead to an anaphylactoid reaction. Dextran antibodies can be intercepted without an immune response by injection of small dextran molecules (MW 1000), thus obviating any incompatibility reaction to subsequent infusion of the dextran plasma substitute solution. 

Laxenaire MC, Charpentier C, Feldman L. Reactions anaphylactoides aux substituts colloidaux du plasma incidence, facteurs de risque, mecanismes. Enquete prospective multicentrique frangaise. Groupe franqais d Etude de la Tolerance des Substituts Plasmatiques. [Anaphylactoid reactions to colloid plasma substitutes incidence, risk factors, mechanisms. A French multicenter prospective study.] Ann Fr Anesth Reanim 1994 13(3) 301-10. 

Anaphylactoid reactions to plasma substitutes present a similar clinical picture, ranging from mild skin manifestations to severe circulatory shock (Schoning and... 

In recent years an increase of the number of reported anaphylactoid reactions induced by plasma substitutes has been observed. A similar increase is also apparent for reactions to many other drugs (Fisher 1975 Furhoff 1977). These higher figures may reflect either a true increase in incidence or greater reporting. Evidence for the latter has been provided by Bottiger et al. (1979). 

ScHONiNG and Koch (1975) performed a randomized study on the incidence of anaphylactoid reactions to five plasma substitutes in orthopedic patients. Each... 

To summarize, the incidence of anaphylactoid reactions to plasma substitutes is low. For comparison, it is less than that to blood, ranging from l%-6% (Mol-LisoN 1972 Kaars-Sijpesteijn and Huizinga 1975 Silver 1976). 

The pathomechanism of HES-induced anaphylactoid reactions is unknown. Since HES has been in general clinical use for a comparatively short time, only a few data are available for critical evaluation of the triggering mechanisms of adverse reactions. From the physicochemical properties of HES a few possible mechanisms may, however, be visualized. Comparing the occurrence in humans of preformed antibodies reactive with plasma substitutes, it is evident that both titers and frequency are highest for gelatin, intermediate for dextran, and lowest for HES. In this connection, it is interesting to note that upon rapid infusion of HES into hu-... 

Hedin H, Richter W, Messmer K, Renck H, Ljungstrom KG, Laubenthal H (1981 b) Incidence, pathomechanism and prevention of dextran induced anaphylactoid/anaphylactic reactions in man. Dev Biol Stand 48 179-189 Hehre EJ, Neill JM (1946) Formation of serologically reactive dextrans by streptococci from subacute bacterial endocarditis. J Exp Med 83 147-162 Hehre EJ, Sugg JY (1950) Serological reactivity of dextran plasma substitute. Fed Proc 9 383... 

Lorenz W, Doenicke A, Reimann HJ, Schmal A, Schwarz B, Dorman P (1978) Anaphylactoid reactions and histamine release by plasma substitutes a randomized controlled trial in human subjects and in dogs. Agents Actions 8 397-399 Liiben G, Quast U, Geiger H (1981) Prekallikrein activator levels and side effects with human albumin preparations. Dev Biol Stand 48 123-127 Lund N (1973) Anaphylactic reactions induced by infusion of haemaccel. Br J Anaesth 45 929... 

---