A Case Report on Allergic Rash Caused by Icodextrin

Abstract

Icodextrin may be used as an alternative to glucose as the osmotic agent in peritoneal dialysis with ultrafiltration failure. In general, icodextrin is known to be safe and well tolerated, but it can also cause hypersensitivity reactions such as skin rashes. Allergic rashes are generally defined as erythematous, itchy and maculopapular, visible over the trunk and the extremities. When a rash occurs, it generally develops early in therapy, is self-limited, and resolves without sequelae after the discontinuation of icodextrin. Although the safety and efficacy of icodextrin peritoneal dialysis solution is well documented, clinicians should be aware of the possibility of severe adverse cutaneous reactions to it. We report the case of a 23-year-old female who developed a skin rash following the use of icodextrin.

Icodextrin-associated generalized exfoliative skin rash in a CAPD patient: a case-report

“…Icodextrin-related skin hypersensitivity should be suspected in patients developing skin rash typically within a few days or a few weeks after initial exposure [ 6 – 11 ], in the absence of any other profound etiology for the allergic reaction (e.g. modification in the orally administered drugs and changes in the patient’s diet or lifestyle habits).…”

“…modification in the orally administered drugs and changes in the patient’s diet or lifestyle habits). Additional strength to the diagnosis of icodextrin-related skin hypersensitivity is provided by the improvement or full remission of the skin lesions within a few days or weeks of withdrawing icodextrin from the peritoneal dialysis regimen [ 6 – 11 ]. This is in line with pharmacokinetic properties of this agent, since icodextrin is shown to have a plasma half-life of 14.7 h and its metabolites are eliminated from plasma within 3 to 7 days after icodextrin discontinuation, depending on the residual renal function [ 15 ].…”

“…In most cases, icodextrin-related skin lesions are limited to the palms and soles and do not mandate the permanent withdrawal of icodextrin from the peritoneal dialysis regimen. In rare occasions, however, exposure to icodextrin may be accompanied by widespread exfoliative dermatitis, acute generalized exanthematous pustulosis, maculopapular rash or chronic lymphocytic vasculitis [ 6 – 11 ]. These severe episodes of skin hypersensitivity typically occur within a few days or weeks of the initial exposure and necessitate the permanent discontinuation of icodextrin [ 6 – 11 ].…”

Bullous pemphigoid in patients receiving peritoneal dialysis: a case series and a literature survey

“…These medications might be a potential trigger of the disease development, although they had been prescribed for more than years in all the cases. Moreover, icodextrin has been reported to induce allergic skin disorders, such as rash or pruritus [ 29 ], thus, it would also affect the onset of BP. The exposure to icodextrin was a common factor among the three cases.…”