Dextran hypersensitivity

Richter, A. W.; Hedin, H.

doi:10.1016/0167-5699(82)90073-1

Cited by 60 publications

(26 citation statements)

References 28 publications

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“…In dextran-derived complexes, however, there is no correlation between complex stability and molecular weight [29, 34, 35]. As intravenous dextran was known to cause severe anaphylaxis, new intravenous iron preparations were developed consisting of dextran-free carbohydrate shells [36, 37]. Although newer intravenous iron formulations such as ferric carboxymaltose and iron (III) isomaltoside 1000 are considered to be much safer than earlier generations of iron products [14], it may be that the molecular structure, carbohydrate complexes of i.v.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Reported Rates of Severe Hypersensitivity Reactions Associated with Ferric Carboxymaltose and Iron (III) Isomaltoside 1000 in Europe Based on Data from EudraVigilance and VigiBase™ between 2014 and 2017

Ehlken¹,

Nathell²,

Gohlke³

et al. 2018

Drug Saf

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IntroductionHypersensitivity reactions (HSRs) are among the known adverse events of intravenous (i.v.) iron products. Of these, particularly severe HSRs such as anaphylaxis are of great clinical concern due to their life-threatening potential.MethodsThis was a retrospective pharmacoepidemiological study with a case-population design evaluating the number of reported severe HSRs following administration of the two i.v. iron products—ferric carboxymaltose and iron (III) isomaltoside 1000—in relation to exposure in European countries from January 2014 to December 2017. Exposure to both products was estimated using IQVIA MIDAS sales data in European countries. Information on spontaneously reported severe HSRs was obtained from and analysed separately for the two established safety surveillance databases EudraVigilance and VigiBase™ using the MedDRA® Preferred Terms anaphylactic reaction, anaphylactic shock, anaphylactoid reaction and anaphylactoid shock associated with administration of either product.ResultsBetween 2014 and 2017, the reporting rate of severe HSRs per 100,000 defined daily doses (100 mg dose equivalents of iron) varied from 0.3 to 0.5 for ferric carboxymaltose and from 2.4 to 5.0 for iron (III) isomaltoside 1000. The reporting rate ratio for iron (III) isomaltoside 1000 versus ferric carboxymaltose was between 5.6 (95% CI 3.5–9.0) and 16.2 (95% CI 9.4–27.8).ConclusionsFindings suggest that iron (III) isomaltoside 1000 is associated with a higher reporting rate of severe HSRs related to estimated exposure than ferric carboxymaltose in European countries. Future research investigating the occurrence of severe HSRs associated with i.v. ferric carboxymaltose and iron (III) isomaltoside 1000 is needed to broaden the evidence for benefit-risk assessment.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Reported Rates of Severe Hypersensitivity Reactions Associated with Ferric Carboxymaltose and Iron (III) Isomaltoside 1000 in Europe Based on Data from EudraVigilance and VigiBase™ between 2014 and 2017

Ehlken¹,

Nathell²,

Gohlke³

et al. 2018

Drug Saf

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“…We have previously analyzed the appearance of dextran-reactive antibodies (DRA) in this group of children (Bjorksten et al, 1982;Hattevig et al, 1983). Since it has been suggested that anaphylactoid reactions to clinical dextran are more common in atopic than in non-atopic patients (Richter & Hedin, 1982), the levels of DRA were related to IgE antibody levels and to atopic disease. There was however no correlation between clinical atopy or total S-IgE and titres of DRA.…”

Section: Discussionmentioning

confidence: 99%

Clinical symptoms and IgE responses to common food proteins in atopic and healthy children

Hattevig

Kjellman

Johansson

et al. 1984

Clin Experimental Allergy

181

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Summary The appearance of symptoms suggestive of allergy through the first 4 years of life was studied prospectively in eighty‐six healthy newborn babies. Blood samples were obtained at birth, at 3,8,25 and 48 months of age and analyzed for levels of total serum IgE and for IgE antibodies to some common foods. The occurrence of IgE antibodies was related to atopic manifestations and to a detailed history of infant feeding and family history of allergy. All infants with elevated cord blood IgE (more than 1.3 kU/1) developed manifestations of atopy. Specific IgE antibodies against egg, cow's milk and soy were demonstrated at 3, 8, 25 and 48 months in nine, twenty‐three, six and two children respectively. Egg was a more potent sensitizing agent than cow's milk, IgE antibodies to egg being present in thirty‐one samples, to cow's milk in eleven and to soy in five samples. Nine infants developed IgE antibodies to eggs or cow's milk before the introduction of these nutrients into the food. The IgE antibody levels were generally low in healthy non‐atopic children and did, with one exception, not reach RAST class 1. In contrast, the levels of IgE antibodies to egg or cow's milk were higher in eleven blood samples from atopic children. We conclude that transient low IgE antibody responses to food proteins appear relatively often even in healthy infants. High concentrations of IgE antibodies however are almost exclusively seen in infants with atopic disease. Sensitization may appear early in infancy sometimes even before the offending food has been introduced into the diet.

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“…Pretreatment with hapten-dextran was used in three of the studies [44,46,47], and this may have reduced the risk of anaphylaxis to dextran [53], Based on the limited information available, hemodilu tion seems to have little effect on the occurrence of cardiac events, most importantly acute myocardial infarction and left ventricular failure. Circulatory events were only rarely reported in the studies published before 1985.…”

Section: Adverse Reactionsmentioning

confidence: 99%

Hemodilution in Acute Stroke

Asplund¹

1991

Cerebrovasc Dis

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Intentional hemodilution has been shown to increase cerebral blood flow under normal conditions and in experimental stroke. Clinical trials of hemodilution in patients with acute stroke have employed dextran, hydroxyethyl starch or albumin as hemodiluting agents, often in combination with venesection. An overview of 12 randomized clinical trials of hemodilution in acute stroke (total 2,509 patients) shows no overall effect on survival (odds ratio 1.01 for active treatment:control). In surviving patients, neurological outcome is similar in hemodilution and control groups. The proportion of patients that are independent at follow-up does not differ between the groups (odds ratio 0.98). It has not been possible to identify any subgroup in which the therapy is clearly beneficial. Recent pilot clinical studies indicate that the effects of more aggressive hemodilution schemes could be worthwhile to explore. Until the results of new controlled trials are available, it seems that hemodilution has no place in the routine management of patients with ischemic stroke.

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Dextran hypersensitivity

Cited by 60 publications

References 28 publications

Evaluation of the Reported Rates of Severe Hypersensitivity Reactions Associated with Ferric Carboxymaltose and Iron (III) Isomaltoside 1000 in Europe Based on Data from EudraVigilance and VigiBase™ between 2014 and 2017

Evaluation of the Reported Rates of Severe Hypersensitivity Reactions Associated with Ferric Carboxymaltose and Iron (III) Isomaltoside 1000 in Europe Based on Data from EudraVigilance and VigiBase™ between 2014 and 2017

Clinical symptoms and IgE responses to common food proteins in atopic and healthy children

Hemodilution in Acute Stroke

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