Risk factors for allergic reaction at initial therapeutic plasma exchange in a single-center study: beware of high rates of severe allergic reaction

Abstract

Background: Therapeutic plasma exchange (TPE) is an important treatment modality for various diseases, but its use can be restricted by allergic reactions (AR). The aim of our study was to elucidate the frequency of and risk factors for AR at initial TPE using fresh frozen plasma (FFP).Methods: Presences of AR were extracted from the medical records of consecutive patients receiving TPE from 2002 to 2012. The following data at initial TPE were retrieved: age, gender, history of allergy, steroid use, timing of steroid use, mean steroid dose, immunosuppressant use, indication for TPE, and laboratory data.Results: Eighty-eight patients (median age 57 years) underwent TPE, and 28% had an episode of AR. Younger age (odds ratio (OR), 1.04 (95% CI, 1.01-1.08)) and indications other than hepatic insufficiency (OR, 17.8 (95% CI, 1.95-429.4)) were associated with higher incidence of AR.Conclusions: Close observation for AR may be warranted at initial TPE for these conditions.

Chronic Renal Failure as a Possible Risk Factor for Allergic Reaction in Therapeutic Plasma Exchange Using Fresh Frozen Plasma

“…Similar to the present study, Hisamichi et al (27) reported the higher incidence of allergic reactions in patients with younger age and indications other than hepatic insufficiency as risk factors for allergic reactions in initial TPE using FFP. In contrast to our study, they mainly focused on liver failure, not on CRF due to the small number.…”

“…ACE inhibitor is also a well‐known cause for allergic reactions through the blockade of kinase I and II, inactivating enzymes of bradykinin . Thus, we included age and ACE inhibitors into the multivariate analysis and concluded the independent impact of CRF on allergic reactions for patients undergoing TPE.…”

Evaluating Risk Factors for Developing Allergic Reactions during Plasma Exchange Using Fresh-frozen Plasma: A Single-center Retrospective Study

“…Several studies have reported the frequency and predictors of allergic reactions in PEx therapy using FFP as a replacement fluid (10)(11)(12). In addition, predictive factors for allergy onset have included a young age, diseases other than liver failure (10), chronic kidney disease (11), hyperbilirubinemia (12), and hematocrit <28.5% (13). However, these reports also differ with regard to the primary disease and diagnosis of allergic reactions.…”

Hemolytic Uremic Syndrome: An Increasingly Recognized Public Health Problem

“…9,18,21 The merits of a new treatment modality, such as rhTM, which may work favorably in some subsets of patients with HUS as well as patients with DIC, 23,24,26 should be rigorously examined in systemic randomized trials. In contrast, the efficacy of corticosteroids for preventing allergic reactions in patients who receive PEX therapy with FFP as the replacement fluid remains unclear, 34 although marginal effects with these agents on hematological and/or renal parameters have been shown in patients with HUS. 35 Ultimately, whether or not our patient benefitted from the intravenous administration of hydrocortisone sodium succinate is unclear.…”