Recurrent anaphylaxis during cardiac catheterization due to ethylene oxide

Hamad, Ahmad; Iweala, Onyinye I.; Henderson, Cory; Madan, Shivanshu; Stouffer, George A.; Commins, Scott P.; Kim, Edwin

doi:10.1016/j.jaip.2018.04.017

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Historically, EtO sensitivity was confirmed with skin tests and serologic studies including basophil activation and radioallergosorbent test 3,7,9,12,17,22,31 . Poothill was the first to demonstrate a positive skin test and IgE antibodies against human serum albumin sterilized with EtO (HSA‐EtO) in a chronic dialysis patient 3 .…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15] Historically, EtO sensitivity was confirmed with skin tests and serologic studies including basophil activation and radioallergosorbent test. 3,7,9,12,17,22,31 Poothill was the first to demonstrate a positive skin test and IgE antibodies against human serum albumin sterilized with EtO (HSA-EtO) in a chronic dialysis patient. 3 In larger studies, IgE antibodies reactive with HSA-EtO were identified in 12% to 42% of all dialysis patients, with higher rates seen in patients with allergic reactions (63%-88%).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 EtO is widely used to sterilize heat labile plastics, including intravenous tubing and commercial apheresis kits used for apheresis, photopheresis, and blood component collection. 2 Allergic reactions to EtO, including anaphylaxis and death, have been reported in patients undergoing dialysis, [3][4][5][6][7][8][9][10][11] plateletpheresis, 12,13 plasmapheresis, 14 photopheresis, 15 cardiac bypass, 16 EtO-sterilized cardiac stents, 17 and blood transfusion through EtO-sterilized leukofiltration filters. 18 Because such allergic reactions are relatively rare, they can go unrecognized due to lack of awareness and knowledge.…”

Section: Introductionmentioning

confidence: 99%

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Ethylene oxide‐type hypersensitivity reactions in G‐CSF mobilized, peripheral blood hematopoietic progenitor cell donors and review

Cooling

Sherbeck

2023

J of Clinical Apheresis

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Background: Ethylene oxide (EtO) is a volatile, ringed toxic ether used to sterilize heat-labile plastics including apheresis sets. In the 1980s, EtO-associated severe hypersensitivity reactions during hemodialysis led to widespread adoption of alternative sterilization for dialysis kits but not apheresis tubing sets. We now report several cases of EtO-type hypersensitivity reactions in autologous donors undergoing hematopoietic progenitor cell collection (HPCC). Materials and Methods: A 10-year retrospective review of allergic EtO-type reactions in adults undergoing HPCC on the COBE Spectra and SPECTRA Optia was performed. Donor medical history and absolute eosinophil counts were compared between cases and 34 HPCC controls. Published EtO reactions during extracorporeal procedures were reviewed with statistical analysis. Graphics and statistics were performed using commercial software.Results: Three autologous HPCC donors experienced EtO-type reactions within 15 min of initiating HPCC, for a 10-year incident rate of 0.08% per procedure and 0.18% per donor. All three reactions occurred using the Spectra Optia and IDL tubing set, for an Optia/IDL specific rate of 0.2% per procedure and 0.5% per donor. There was no correlation between EtO reactions, eosinophil counts, or saline prime dwell times. No patient had classic predisposing risk factors for EtO hypersensitivity. Two patients required medical intervention whereas the third responded by pausing the procedure and slowing the inlet rate.Conclusion: EtO-type hypersensitivity reactions can be observed during HPCC, especially with the Optia IDL tubing set. EtO reactions may be missed due to their rarity and staff unfamiliarity with this clinical entity.

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Section: Discussionmentioning

confidence: 99%