Dextran Anaphylaxis

Abstract

In recent years there has been renewed interest in the use of dextran, not as a plasma expander, but in the treatment of thrombophlebitis and arterial insufhciency. We would like to report our experience of 7 cases of anaphylaxis in 40 patients treated with dextran; molecular weight 75,000 ± 15,000.1 Three of these reactions were related to dextran supplied by one drug company and the others connected with dextran from another company. We have found in reviewing the literature that this incidence of 17 per cent is much higher than ever previously reported after administration of dextran. 2-10 Several extensive studies of the clinical use of this polysaccharide have revealed a very low incidence of any type of allergic reactions.Although dextran, a polysaccharide product of the fermentation of sucrose by the organism Leuconostoc mesenteroides, has long been known to be allergenic in humans, the incidence of adverse reactions has been very low. Dextran was first used in the United States in 1953 in the control of shock from war wounds and has been widely used since without many major problems.We treated 40 patients with either thrombophlebitis or inoperable peripheral arterial insufficiency with dextran. The following examples are illustrative case reports of four patients out of the seven who developed anaphylaxis while receiving this therapy; no other drugs were being administered at the time of the reaction. CASE REPORTSM. B., a 34-year-old white woman, developed pain, tenderness and swelling in the left lower leg 30 days after surgery for a herniated lumbar disc. There was marked tenderness in the calf of the left leg. Homan's sign was positive. She was diagnosed as having thrombophlebitis of her lower left leg. She was adequately anticoagulated with sodium warfarin, but had persistent swelling, calf and femoral tenderness and positive Homan's sign. Dextran, 6 per cent, was started. After 30 drops at 5 to 7 drops per min., she had the prodromal symptoms of diffuse tingling, hot flushed sensation and later respiratory difficulty. She became cyanotic, with periods of apnea and gasping respirations.Pulse and blood pressure were unobtainable, and the heart sounds were barely audible. The dextran was stopped and the patient was treated with adrenalin, vasopressors and corticosteroids. After 4 hr., she was improved and had an uneventful hospital course.

Histamine Release in Human Subjects by Modified Gelatin (Haemaccel) and Dextran: An Explanation for Anaphylactoid Reactions Observed Under Clinical Conditions?

“…Thus, it would appear that anaphylactoid reactions to dextran do not have to be caused by histamine release, although this mechanism cannot be excluded in all of the cases reported in the literature, since dextran did indeed release histamine in some of our volunteers. The clinical symptoms, however, which have been described in reports on anaphylactoid reactions to dextran, differ from those observed after infusion of Haemaccel (Maycock, 1952;Tarrow and Pulaski, 1953;Wilkinson and Storey, 1953;Tarrow, 1955;Wilkinson, 1956;Henley, McPhaul and Albert, 1958;Thorsen, 1959;Thompson, 1960;Meissner, 1961;Shepherd and Vandam, 1964;Simone, 1965;Bailey et al, 1967;Brisman, Parks andHaller, 1968, 1971;Maltby, 1968;Michelson, 1968;Strebel and Siegler, 1968;Maddi, Wyso and Zinner, 1969;Kohen et al, 1970;Schobinger, 1970;Carlsson et al, 1972;Schoning, Krahl and Koch, 1973). An increased intestinal motility with defaecation, rapidly developing and often severe hypotension and bronchospasm are dominant in the clinical picture, whereas skin reactions are not reported very frequently.…”

Dextran-induced Anaphylactoid Reactions in Man

“…The clinical picture of DIAR corres ponds to that of immediate allergic reac tions (type 1), which explains why case re ports are often classified as anaphylaxis [5,14,21,37,38,55]. However, rcaginic anti bodies with dextran specificity have appar ently been demonstrated only in a single pa tient [31. Among the 100 cases studied here one showed moderately increased levels of DRA of IgE class measured by the highly sensitive RAST technique, and slight, sta tistically significant increases were seen in 24.…”