Plasma serotonin and histamine levels in hemodialysis-related pruritus are not significantly influenced by 5-HT3 receptor blocker and antihistaminic therapy

Weißhaar, Elke; Dunker, Nadine; Domröse, Ute; Kh, Neumann; Gollnick, Harald

doi:10.5414/cnp59124

Cited by 16 publications

(12 citation statements)

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“…It has been described to be raised in patients with renal impairment without any positive correlation of serotonin levels with pruritus (10,11). This is contrary to a very recent study investigating platelet‐poor plasma of pruritic HD patients where serotonin levels ranged within normal limits, no matter whether patients were treated with 5‐HT3 receptor antagonists such as tropistron and ondansetron or not (12). Most likely, elevated serotonin levels in previous studies (10,11) are due to measuring the total blood pool of serotonin including the intraplatelet component (10).…”

Section: Discussioncontrasting

confidence: 85%

“…Case reports and series showed that 5‐HT3 receptor antagonists sufficiently abolish renal pruritus (9,11,13), but controlled clinical studies have not verified this (15,16). Our study confirms these findings in a clinical‐experimental setting and stands out having two certain characteristics: firstly, we investigated two different 5‐HT3 receptor antagonists (tropisetron and ondansetron) in the same groups of HD patients, and secondly, the present data were obtained from the same subjects examined for plasma serotonin and histamine (12). Hence, these results harmonize our previous findings.…”

Section: Discussionsupporting

confidence: 83%

“…In summary, a role for serotonin receptor antagonists in renal pruritus appears unlikely but not definitively excluded: whole blood serotonin levels may be elevated in chronic renal failure, especially in those on CAPD, while the levels of free plasma serotonin are not (12). There is a wide variation in the bioavailability of 5‐HT3 receptor antagonists through variable absorption between individuals, route of administration and dose prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…pregnancy and limited vigilance), concomitant diseases (e.g. atopy, allergy, acute or chronic dermatoses, hepatitis and neoplasm) and medication (corticosteroids, antihistamine and drugs with antihistaminic potency); they have been described and published in detail before (12). The aetiologies for renal failure were pyelonephritis ( n = 2), glomerulonephritis ( n = 2), cystic kidney type Potter 2 ( n = 2), Alport syndrome ( n = 1), nephrosclerosis ( n = 1), vasculitis ( n = 1), amyloidosis ( n = 1) and renal insufficiency of unknown origin ( n = 1).…”

Section: Methodsmentioning

confidence: 99%

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Antipruritic effects of two different 5‐HT3 receptor antagonists and an antihistamine in haemodialysis patients

Weißhaar

Dunker

Röhl

et al. 2004

Experimental Dermatology

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Pruritus is the most distressing symptom in haemodialysis (HD) patients. Its aetiology has not yet been delineated, and thus there are no good therapeutical options. Case reports and series attribute antipruritic potency to the serotonin receptor antagonists of the 5-HT3 type in renal pruritus. It was the aim of this study to investigate the antipruritic effect of two different 5-HT3 receptor antagonists and an antihistamine in 11 patients undergoing HD. Pruritus was induced by iontophoresis with serotonin and histamine and recorded before and after HD. These data were compared to those obtained after oral pretreatment with the 5-HT3 receptor antagonists tropisetron 5 mg and ondansetron 8 mg and the antihistamine cetirizine 10 mg. Ten healthy volunteers served as a control group. Vasocutaneous parameters (wheal and flare), skin temperature and alloknesis were also determined. Itching in HD patients and controls was not significantly diminished by oral pretreatment with the serotonin receptor antagonists. In controls, but not in HD patients, cetirizine significantly reduced itching, skin temperature and vasocutaneous parameters. Our data additionally demonstrate that there are no significant differences in vasocutaneous parameters, itching and alloknesis in HD patients before and after dialysis. We conclude that 5-HT3 receptor blockers such as tropisetron and ondansetron and the antihistamine cetirizine do not sufficiently reduce serotonin- and histamine-induced itching in haemodialyis patients.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Antipruritic effects of two different 5‐HT3 receptor antagonists and an antihistamine in haemodialysis patients

Weißhaar

Dunker

Röhl

et al. 2004

Experimental Dermatology

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“…However, current research reveals mixed reports in this area, and the effectiveness of treatment may vary according to the type of pruritus studied. For example, in patients with cholestatic itch, either some or no benefit has been reported [120,121], whilst only marginal or no relief has been reported for hemodialysis-related pruritus [122,123]. However, the underlying mechanisms of this disorder are still poorly understood and will need further work if a therapeutic potential is to be realised [124].…”

Section: Therapeutic Potentialmentioning

confidence: 99%

5-HT3 Receptors

Thompson

Lummis

2006

CPD

204

173

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The 5-HT(3) receptor is a member of the Cys-loop family of ligand-gated ion channels. These receptors are located in both the peripheral and central nervous systems, where functional receptors are constructed from five subunits. These subunits may be the same (homopentameric 5-HT(3A) receptors) or different (heteropentameric receptors, usually comprising of 5-HT(3A) and 5-HT(3B) receptor subunits), with the latter having a number of distinct properties. The 5-HT(3) receptor binding site is comprised of six loops from two adjacent subunits, and critical ligand binding amino acids in these loops have been largely identified. There are a range of selective agonists and antagonists for these receptors and the pharmacophore is reasonably well understood. There are also a wide range of compounds that can modulate receptor activity. Studies have suggested many diverse potential disease targets that might be amenable to alleviation by 5-HT(3) receptor selective compounds but to date only two applications have been fully realised in the clinic: the treatment of emesis and irritable-bowel syndrome.

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