We report three patients with massive eosinophilia of different etiology who developed bronchoconstriction, hypotension, and shock shortly after dialysis or leukapheresis had been begun. In two cases, ethylene oxide-free materials had been used ruling out an allergic reaction related to this compound. Degranulation of eosinophils with release of eosinophil peroxidase may have caused the observed adverse reactions, as suggested by in vitro experiments with blood from the three patients. Our observations draw attention to the fact that extracorporeal therapies may initiate life-threatening complications in patients with severe eosinophilia.
SalemM., IvanovichP.T., IngT.S., DaugirdasJ.T.Adverse effects of dialyzers manifesting during the dialysis session. Nephrol Dial Transplant1994; 9(suppl 2): S127–37.
2.
VerresenL., WaerM., VanrenterghemY., MichielsenP.Angiotensin-converting-enzyme inhibitors and anaphylactoid reactions to high-flux membrane dialysis. Lancet1990; 336: 1360–2.
3.
CramerR., SoranzoM.R., DriP., MenegazziR., PitottiA., ZabucchiG., PatriarcaP.A simple reliable assay for myeloperoxidase activity in mixed neutrophil-eosinophil cell suspensions: Application to detection of myeloperoxidase deficiency. J Immunol Methods1984; 70: 119–25.
4.
HonkanenE., Gronhagen-RiskaC., TeppoA.M., HiltunenU.Clinical testing of a new, low-flux polysulfone membrane. Results of a 26-week study. Blood Purif1989; 7: 240–6.
5.
RockelA., ThielC., AbdelhamidS., FiegelP., WalbD.Three cases of hemodialysis-associated hypersensitivity reactions. Int J Artif Organs1985; 8: 179–80.
6.
BackenrothR., SpinowitzB.S., GallerM., GoldenR.A., RascoffJ.H., CharytanC.Comparison of eosinophilia in patients undergoing peritoneal dialysis and hemodialysis. Am J Kidney Dis1986; 8: 186–91.
RemesS., KorppiM., RemesK., SavolainenK., MononenI., PekkanenJ.Serum eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in childhood asthma: The influence of atopy. Pediatr Pulmonol1998; 25: 167–74.
9.
WintherL., MoseholmL., ReimertC.M., Stahl SkovP., Kaergaard PoulsenL.Basophil histamine release, IgE, eosinophil counts, ECP, and EPX are related to the severity of symptoms in seasonal allergic rhinitis. Allergy1999; 54: 436–45.
10.
NiimiA., AmitaniR., SuzukiK., TanakaE., MurayamaT., KuzeF.Serum eosinophil cationic protein as a marker of eosinophilic inflammation in asthma. Clin Exp Allergy1998; 28: 233–40.
11.
ElsnerJ., KappA.Regulation and modulation of eosinophil effector functions. Allergy1999; 54: 15–26.
12.
GundelR.H., LettsL.G., GleichG.J.Human eosinophil major basic protein induces airway constriction and airway hyperresponsiveness in primates. J Clin Invest1991; 87: 1470–73.
