Hydroxyethyl Starches and Pruritus: A Real Problem?

Dettori, Nadia; Spahn, Donat R.

doi:10.1111/j.1778-428x.2003.tb00181.x

Cited by 2 publications

(5 citation statements)

References 29 publications

(37 reference statements)

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“…In addition, future clinical studies should be designed to assess HES‐induced pruritus adequately, including its dose dependency and incidence in specific patient populations. Large outcome studies, with administration of substantial HES doses and ideally skin biopsies, have been recommended to assess the true incidence and pathophysiological mechanisms of pruritus 44 . Such studies should be conducted for each HES solution that is or will be widely used for clinical fluid management.…”

Section: Discussionmentioning

confidence: 99%

“…Large outcome studies, with administration of substantial HES doses and ideally skin biopsies, have been recommended to assess the true incidence and pathophysiological mechanisms of pruritus. 44 Such studies should be conducted for each HES solution that is or will be widely used for clinical fluid management.…”

Section: Discussionmentioning

confidence: 99%

“…15 In particular, deposition in Schwann cells of cutaneous nerves appears to be one likely mechanism. [42][43][44] Whether HES-containing cells such as macrophages, endothelial cells, keratinocytes, Langerhans cells, or other cells release mediators that provoke itching or exert a more direct effect on sensory nerve fibres remains uncertain. It has been suggested that HES deposits may mechanically irritate nerve endings, thus provoking pruritus.…”

Section: Pathogenesismentioning

confidence: 99%

“…Pruritus has been consistently encountered in connection with HES deposition in small peripheral nerves 15 . In particular, deposition in Schwann cells of cutaneous nerves appears to be one likely mechanism 42–44 . Whether HES‐containing cells such as macrophages, endothelial cells, keratinocytes, Langerhans cells, or other cells release mediators that provoke itching or exert a more direct effect on sensory nerve fibres remains uncertain.…”

Section: Pathogenesismentioning

confidence: 99%

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Pruritus precipitated by hydroxyethyl starch: a review

Bork

2005

British Journal of Dermatology

116

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Hydroxyethyl starch (HES) is widely used for fluid management in broad populations of patients, particularly in the surgery and intensive care settings. Pruritus, often manifested as pruritic crises, is increasingly being recognized as a common major adverse effect of HES administration. This iatrogenic form of pruritus is frequently severe and protracted with a serious negative impact on patient quality of life, including sleep disturbance, disruption of daily routine and mental distress. Such pruritus is generally refractory to available therapies and can persist for up to 12-24 months. All currently clinically available HES solutions entail the risk of pruritus, including those of diverse molecular weights and substitutions. Although dose dependent, HES-induced pruritus nevertheless can often be provoked by relatively low routine doses. The pathophysiological basis for pruritus is the widespread tissue deposition of HES, prominently in macrophages. HES tissue deposits are long lasting and sometimes massive. Usually several weeks elapse between HES exposure and the onset of pruritus. Consequently, it is important to inquire about prior HES exposure in the diagnostic evaluation of pruritus sine materia. Awareness about the scope of the pruritus problem needs to increase among physicians administering HES. Well-designed clinical outcome studies are needed to assess more fully the incidence, dose dependency and mechanisms of pruritus with particular HES solutions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

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Pruritus precipitated by hydroxyethyl starch: a review

Bork

2005

British Journal of Dermatology

116

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“…Though the mechanisms are not fully understood, pruritus is consistently associated with HES deposition in small peripheral nerves, especially Schwann cells of cutaneous nerves [80,[82][83][84]. Mechanical irritation of the nerves by HES deposits may contribute to clinical manifestations [85].…”

Section: Tissue Depositionmentioning

confidence: 99%

Hydroxyethyl starch – can the safety problems be ignored?

Wiedermann

2004

Wien Klin Wochenschr

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Hydroxyethyl starch (HES) has come into widespread use for fluid management of acutely ill patients. Certain characteristic complications of HES, notably renal impairment, hemorrhage and pruritus, have been well documented with all types of HES solutions. The use of HES solutions with lower molecular weight and substitution has been claimed to minimize these safety risks. In particular, solutions of 200 kDa molecular weight and 0.5 substitution (HES 200/0.5) and of 130 kDa molecular weight and 0.4 substitution (HES 130/0.4) have been advocated for their superior safety profile. A critical appraisal of the available evidence does not provide reassurance that these or other HES solutions are risk free. Most evidence indicates the equivalence of HES 200/0.5 and HES 130/0.4 with respect to effectiveness for volume expansion. Since HES 130/0.4 is newer, its safety profile is less well characterized; however, it appears to share the same complication risks as those of HES 200/0.5. In randomized clinical trials employing sensitive markers, both HES 200/0.5 and HES 130/0.4 have been shown to impair renal function. Both coagulopathy and clinical bleeding have been documented after administration of either HES 200/0.5 or HES 130/0.4, and the magnitude of negative effects on hemostasis has been similar for these two HES solutions. Pruritus is a common side effect of all HES solutions, including HES 200/0.5 and HES 130/0.4, and can occur in diverse clinical settings in some cases after only small HES doses. Typically presenting as pruritic crises of delayed onset, this complication is often severe, protracted and refractory to treatment. An additional risk of HES infusion is the occurrence of potentially life-threatening anaphylactoid reactions, which are 4.5 times as frequent after HES as albumin exposure. Limiting the dose and duration of HES therapy may be helpful in lessening the risk of undesired side effects; at present however, reliance on particular HES solutions does not appear sufficient to ensure safety.

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Hydroxyethyl Starches and Pruritus: A Real Problem?

Cited by 2 publications

References 29 publications

Pruritus precipitated by hydroxyethyl starch: a review

Pruritus precipitated by hydroxyethyl starch: a review

Hydroxyethyl starch – can the safety problems be ignored?

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