Dextran-induced Anaphylactoid Reactions in Man

Abstract

Dextran reactive antibodies (DRA) were studied in 123 patients having experienced dextran-induced anaphylactoid reactions (DIAR) during 1970–1975. No evidence for reaginic DRA was obtained by radioallergosorbent technique and passive cutaneous anaphylaxis in Cynomolgus monkeys; total IgE levels were within normal range. It is concluded that DIAR are not mediated by dextran-specific reagins. Further, no reaginic antibodies against potential contaminants from the dextran manufacturing process were demonstrable. In two population samples of normal human sera from Sweden and Germany hemagglutinating DRA (IgG, IgA, and IgM classes) were found in 63 and 74%, high titres (16–256) comprising 14 and 25%. In dextran reactors a direct positive correlation between titres of hemagglutinating DRA and increasing severity of DIAR was observed. The accumulation of high DRA titres in severe reactions may be taken as circumstantial evidence for the causal role of hemagglutinating DRA in these cases. However, if high titres of DRA alone were responsible for triggering DIAR, the expected frequency would be more than thousand times higher than the reported global incidence of DIAR. To explain this discrepancy, involvement of certain Ig classes or subgroups, possibly in combination with other predisposing factors is suggested. In mild reactions DRA appear to play a negligible role. Positive dextran wheal and flare reactions, often correlated with high titres of hemagglutinating DRA, were seen in 32% of dextran reactors, indicating that skin tests are of limited predictive value. No significant difference between sexes, age groups, or pre- and intraoperatively started dextran infusions was observed; association with certain diseases was not apparent.

Immunological Properties of a High Molecular Weight Component from Yeast Cell Autolysate in Dogs and Evaluation of Its Potential Role in Human Dextran Reactions

“…Regarding the clinical relevance of these data to dextran-induced anaphylactoid reac tions in man, it does not seem probable that macromolecular contami nants derived from yeast cell autolysate are causal factors. The absence of reaginic antibodies against yeast autolysate in human dextran reactors [3] also supports this view. Further, serious dextran reactions often occur af ter infusion of a few drops to some milliliters only.…”

“…Summarizing, these findings favor the hypothesis of another pathomechanism of dextran reac tions. Recent experimental results show a positive correlation between ti ter of preformed hemagglutinating dextran reactive antibodies and in creasing severity of dextran reactions, incriminating the dextran molecule itself as triggering agent [3],…”

“…Recent reports on rare anaphylactoid reactions in man [1,8] due to dextran infusions led to renewed discussion of the pathomechanism of these complications [3], Apart from immunological examina tions of the reacting patients, the role of potential impurities in dextran solutions acquired new interest.…”

“…By immuniza tion of rabbits with clinical dextran no antigenic macromolecular contam inants were demonstrable by passive cutaneous anaphylaxis (PCA) in guinea pigs [7]. Further, no reaginic antibodies against yeast autolysate were detected in sera of dextran reactors by PCA in monkeys [3].…”

No Evidence for the Existence of Preformed Antibodies against Hydroxyethyl Starch in Man

“…Contrary to the majority of anaphylactic reactions. IgE antibodies are not relevant [6,[8][9][10]. The incidence of low titres of dextran-reactive antibodies is as high as 70% in a normal population [10].…”