Pathomechanism of Dextran-Induced Anaphylactoid Reactions in Man

Hedin, H.; Richter, Wito; Kraft, D

doi:10.1159/000232873

Cited by 25 publications

(26 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antidextran antibodies of the IgG class are probably responsible for the rare anaphy lactoid reactions seen after infusions of dex tran for the purpose of plasma substitution or improvement of microcirculation [8], We had pointed out earlier that reactions to dextran seem to occur often in patients suf fering from RA, GI ulcers, SLE, and cirrho sis of the liver [7], In RA and ulcers, anti dextran antibodies of the IgG class are fre quently elevated. Reactions to dextran are also more severe and more frequent among aged patients [9] who also, according to our results, often have elevated antidextran an tibody levels.…”

Section: Discussionmentioning

confidence: 99%

Appearance of Dextrans and Antidextran Antibodies in Human Sera

Palosuo¹,

Milgrom²

1981

Int Arch Allergy Immunol

View full text Add to dashboard Cite

The serologically active moiety of an antigen detected occasionally in pathologic sera by double-diffusion gel precipitation tests, referred to in earlier studies as ubiquitous tissue antigen, was identified as a dextran composed predominantly, if not exclusively, of α(1→6)-linked glucopyranoses. By means of an enzyme immunoassay, dextran or dextran-like material, which inhibited the binding of antidextran serum to dextran, was detected in sera of several patients with various gastrointestinal (GI) diseases, especially GI ulcers (7/10), and also often in sera of aged people (9/21). However, 2 of 50 normal blood donor sera and a few sera from almost every disease group studied contained low quantities of dextran-like material. The levels of antidextran antibodies of the IgG class were also often elevated among patients with GI diseases and aged people as demonstrated by enzyme immunoassay with dextran T-500 as the solid phase antigen. OD values exceeding the mean plus 2.5 SD of 106 normal blood donor sera were recorded in 69% of patients with gastric and duodenal ulcers, 40% with ulcerative colitis, 29% with Crohn’s disease, 20% with colorectal carcinomas, and in 21% with rheumatoid arthritis. None of 23 children, but 9 of 23 aged people (35%) had elevated antibody levels. It is suggested that absorption of dextrans from food or their production by intestinal bacteria may be facilitated in various GI diseases.

show abstract

Section: Discussionmentioning

confidence: 99%

Appearance of Dextrans and Antidextran Antibodies in Human Sera

Palosuo¹,

Milgrom²

1981

Int Arch Allergy Immunol

View full text Add to dashboard Cite

show abstract

“…ICs are known to mediate type 3 HSRs in a small subset of people receiving dextran infusions. In these cases, ICs are formed and mediate severe reactions in patients with high antidextran IgG antibody levels (Bircher, Hedin, and Berglund 1995;Hedin et al 1980;Hedin and Richter 1982;Kraft et al 1982;Ljungstrom et al 1983Ljungstrom et al , 1988.…”

Section: Infusion Reactions and Generalized Type 3 Hsrsmentioning

confidence: 99%

Formation, Clearance, Deposition, Pathogenicity, and Identification of Biopharmaceutical-related Immune Complexes

et al. 2014

View full text Add to dashboard Cite

Vascular inflammation, infusion reactions, glomerulopathies, and other potentially adverse effects may be observed in laboratory animals, including monkeys, on toxicity studies of therapeutic monoclonal antibodies and recombinant human protein drugs. Histopathologic and immunohistochemical (IHC) evaluation suggests these effects may be mediated by deposition of immune complexes (ICs) containing the drug, endogenous immunoglobulin, and/or complement components in the affected tissues. ICs may be observed in glomerulus, blood vessels, synovium, lung, liver, skin, eye, choroid plexus, or other tissues or bound to neutrophils, monocytes/macrophages, or platelets. IC deposition may activate complement, kinin, and/or coagulation/fibrinolytic pathways and result in a systemic proinflammatory response. IC clearance is biphasic in humans and monkeys (first from plasma to liver and/or spleen, second from liver or spleen). IC deposition/clearance is affected by IC composition, immunomodulation, and/or complement activation. Case studies are presented from toxicity study monkeys or rats and indicate IHC-IC deposition patterns similar to those predicted by experimental studies of IC-mediated reactions to heterologous protein administration to monkeys and other species. The IHC-staining patterns are consistent with findings associated with generalized and localized IC-associated pathology in humans. However, manifestations of immunogenicity in preclinical species are generally not considered predictive to humans.

show abstract

“…High-molecular-weight dextrans (40, 70 and 75 kDa) are accompanied by significant side effects including dextran-induced allergic reactions (DIAR) (145,160). These are immune complex mediated by dextran-reactive antibodies of the IgG class.…”

Section: Plasma Volume Expanders (Colloids)mentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

192

197

View full text Add to dashboard Cite

Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

show abstract

Pathomechanism of Dextran-Induced Anaphylactoid Reactions in Man

Cited by 25 publications

References 4 publications

Appearance of Dextrans and Antidextran Antibodies in Human Sera

Appearance of Dextrans and Antidextran Antibodies in Human Sera

Formation, Clearance, Deposition, Pathogenicity, and Identification of Biopharmaceutical-related Immune Complexes

Anaphylaxis during anaesthesia: diagnostic approach

Contact Info

Product

Resources

About