Severe Anaphylaxis in Cirrhotic Patients Receiving Dextran 40

Adar, R

doi:10.1001/jama.1977.03270290019013

Cited by 5 publications

(3 citation statements)

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“…Due to known allergic and anaphylactic reactions to dextran solutions [ 55 , 56 , 57 ], we investigated HES 70/0.5, HES 200/0.5, and a 30% lipid emulsion formulation based on soy bean proteins and triglycerides that could be used to replace dextran solutions. Using HES 200/0.5, 90% of macromolecules >100 kDa, such as HES 200, are not expected to pass through the 100-kDa cut-off microdialysis catheter, as indicated by the manufacturer.…”

Section: Discussionmentioning

confidence: 99%

Cytokine and Chemokine Recovery Is Increased by Colloid Perfusates during Dermal Microdialysis

et al. 2018

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Cytokines and chemokines play important roles in cell signalling, and microdialysis is a promising tool for monitoring these inflammation markers ex vivo. Therefore, the collecting of these mediators at the highest concentrations possible is crucial. Depending on the size of the mediator of interest, the collection of these high molecular mass molecules has thus far been difficult due to their low recovery, even when using high cut-off (100 kDa) microdialysis membranes. This study aimed to optimize the recovery of various cytokines and chemokines by validating the use of different perfusates in cutaneous microdialysis, and comparing intravenous (i.v.) colloids, crystalloids, and a lipid emulsion formulations that are approved for i.v. applications. Methods: In vitro and in vivo recovery experiments using six recombinant cytokines varying in molecular size (interleukin-2 (15 kDa), interleukin-6 (20.5 kDa), interleukin-8 (8 kDa), interleukin-12p70 (70 kDa), TNF-α (17.5 kDa), and vascular endothelial growth factor (VEGF) (38 kDa)) were performed in the presence of different perfusates for i.v. applications: Ringer’s lactate, dextran 60 kDa, hydroxyethyl starch 70 kDa, and hydroxyethyl starch 200 kDa solutions as well as a lipid emulsion formulation. Recovery was determined through (i) microdialysis of cytokines and chemokines in Ringer’s lactate solution or human serum in vitro, and (ii) retrodialysis of excised porcine and human skin cadavers in vitro and porcine skin in vivo. Furthermore, we used skin trauma (catheter insertion) and Ultraviolet B irradiation of 3 × 3 cm2 skin areas to sample cytokines and chemokines in vivo and compared the amounts that were obtained using crystalloid and colloid perfusates. All the cytokines and chemokines within the dialysates were quantified through a flow cytometry-based bead array assay. Results: Overall, recovery was strongly increased by the colloids, particularly hydroxyethyl starch 70 kDa, in vitro, ex vivo, and in vivo. When compared with the recovery achieved using Ringer’s lactate, this increase was most effective for proteins ranging from 8 to 20.5 kDa. Hydroxyethyl starch 70 kDa significantly increased the recovery of interleukin (IL)-8 in human serum in vitro when compared with Ringer’s lactate. More cytokines and chemokines were recovered using colloids compared with crystalloids. However, the increase in recovery values was lower for IL-12p70 and VEGF. Conclusions: Regarding the dialysate volumes and final dialysate concentrations, colloid perfusates are overall superior to crystalloid perfusates, such as Ringer’s lactate, when sampling cytokines and chemokines, resulting in higher recoveries. However, the sampling of high-molecular-mass cytokines during microdialysis remains challenging, and experimental in vitro data are not completely comparable with data obtained ex vivo or in vivo.

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Section: Discussionmentioning

confidence: 99%

Cytokine and Chemokine Recovery Is Increased by Colloid Perfusates during Dermal Microdialysis

et al. 2018

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“…Anaphylactoid reactions occurred in three out of 472 patients (0.6%) receiving dextran, with one patient (0.2%) having a severe (grade III-V) DIAR. Adar [14] reported on severe DIAR in two of ten patients with cirrhosis undergoing surgery. Acute renal failure has also been reported [15].…”

Section: Discussionmentioning

confidence: 99%

“…It is of interest that patients with allergic histories often only developed mild DIAR. The more severe the DIAR is, the earlier it occurs after starting dextran infusion and the smaller the amount of dextran given, eg, 2-20 ml [13,14,17,18].…”

Section: Discussionmentioning

confidence: 99%

The use of dextran‐40 during percutaneous transluminal coronary angioplasty: A report of three cases of anaphylactoid reactions—one near fatal

Brown¹,

Aldridge²,

Schwartz³

et al. 1985

Cathet. Cardiovasc. Diagn.

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Successful percutaneous transluminal coronary angioplasty is achieved by fracture of the atheromatous plaque and perhaps dilatation of the arterial walls to increase the luminal diameter of the artery. Because this "controlled" injury stimulates platelet adhesion on the subendothelial matrix, the use of dextran-40 in addition to heparin has been advocated. The overall incidence of Dextran-induced anaphylactoid reactions at our institution was 0.6% and of severe life-threatening reactions, 0.2%. With the recent doubts cast on the efficacy of dextran-40, the question arises regarding its routine use in PTCA.

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Solutions and Emulsions Used for Intravenous Infusions

Richter¹,

Hedin²

1983

Allergic Reactions to Drugs

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Severe Anaphylaxis in Cirrhotic Patients Receiving Dextran 40

Cited by 5 publications

References 1 publication

Cytokine and Chemokine Recovery Is Increased by Colloid Perfusates during Dermal Microdialysis

Cytokine and Chemokine Recovery Is Increased by Colloid Perfusates during Dermal Microdialysis

The use of dextran‐40 during percutaneous transluminal coronary angioplasty: A report of three cases of anaphylactoid reactions—one near fatal

Solutions and Emulsions Used for Intravenous Infusions

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