Allergy to icodextrin

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

“…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 ]. Skin tests with icodextrin-containing patches, pricks or intra-dermal tests cannot reliably confirm the diagnosis, since these re-challenging tests were unable to reproduce the skin rash in previously reported cases of acute exanthematous generalized pustulosis-like eruption that occurred shortly after exposure to icodextrin [ 4 ]. Notably, skin tests are reported to have a very low sensitivity and specificity in diagnosing such drug-induced skin reactions [ 4 ].…”

“…Skin tests with icodextrin-containing patches, pricks or intra-dermal tests cannot reliably confirm the diagnosis, since these re-challenging tests were unable to reproduce the skin rash in previously reported cases of acute exanthematous generalized pustulosis-like eruption that occurred shortly after exposure to icodextrin [ 4 ]. Notably, skin tests are reported to have a very low sensitivity and specificity in diagnosing such drug-induced skin reactions [ 4 ].…”

“…Biopsy studies showed peritoneal monocyte infiltration and suggested a type IV hypersensitivity reaction mediated through dendritic cells [ 23 ]. Sensitization against icodextrin-related molecules, such as dextran, with formation of cross-reactive antibodies or progressive sensitization against icodextrin itself may be implicated in the complex pathophysiology of adverse skin reactions observed in patients exposed to this agent [ 4 ].…”

Acute generalized exanthematous pustulosis associated with icodextrin

“…5 Cutaneous reactions to icodextrin are estimated to occur in up to 15% of patients 6 ; however, only a limited number of cases of icodextrin-induced AGEP have been reported. [7][8][9] Each case occurred approximately 2 weeks after the initiation of icodextrin and resolved upon discontinuation. Our patient represents a case of icodextrin-associated AGEP and illustrates the need to inquire about recent changes in dialysis solutions in the diagnostic approach to a patient on dialysis who has a diffuse pustular eruption.…”

Lymphocytic Vasculitis Associated with Icodextrin

“…The structure of icodextrin differs from that of the naturally occurring polymeric substance dextran — used as a plasma expander — only in the alpha-1,4 and alpha-1,6 linkage. Although a precise mechanism has not been identified, a putative pathophysiological mechanism may cause sensitization against icodextrin-related molecules, such as dextran, with cross-reactive antibodies, or progressive sensitization against icodextrin itself (6).…”