Pruritus etherified starches

In a retrospective study of 491 patients treated for various cochleovestibular disorders, 25 of 59 patients (42%) treated with etherified starch complained of pruritus, compared with four of 35 (11%) treated with dextran-40 (38). 

In a prospective, randomized, controlled, epidemiological comparison of 6% etherified starch solution (200/0.5) and lactated Ringer s solution, there were no more serious complications with the former than the latter. There was a greater than 10% incidence of pruritus in both groups (44). 

In 26 patients who had received etherified starch (varying widely in both dose and duration), storage of etherified starch was dose-related, and fell in all organs over time tissues deposits were greater in patients with pruritus (45). The authors concluded that tissue deposition is transitory and dose-related, but varies widely between subjects in both severity and duration. In a retrospective postal questionnaire in 100 consecutive intensive care patients who had previously received etherified starch, of 73 patients who replied, 34% had pruritus after discharge, of whom 44% had persistent pruritus that did not resolve with conventional treatments (46). There was a significant relation between the volume of etherified starch infused and the occurrence of pruritus. 

In 120 patients who had received plasma substitutes (including 93 who had received etherified starch) skin biopsies showed lysosomal deposits in the histiocytes, some of them also in the cutaneous epithelium and endothehum (47). The extent of lysosomal storage correlated with the amount of etherified starch infused. Consecutive biopsies in some cases showed a slow reduction (over years) of etherified starch deposits in vacuoles. The authors suggested that pruritus after high cumulative doses of etherified starches was closely related to deposition of etherified starch in cutaneous nerves. 

In a retrospective study of the dose-relatedness of pruritus caused by etherified starch, 50 consecutive patients were evaluated by questionnaire about 6 months after treatment 37 returned the questionnaires, of whom 20... 

An anaphylactic reaction has been attributed to etherified starches during re-infusion of autologous bone marrow in a man treated for malignant lymphoma (6). The re-infused material had been processed using etherified starches. The patient reported pruritus and carpal spasm. Edema and erythema of the hands were present, together with hypotension and tachycardia. A very small amount of etherified starches was present in the processed bone autograft. 

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