Hemodialysis patients with allergic reactions to dialysate whose symptoms improved without dialysate change：Two case reports

Abstract

The diagnosis and treatment of dialysis-associated allergic reactions are important for patients on hemodialysis. Here, we report two cases in which the drug-induced lymphocyte stimulation test (DLST) was positive for dialysate. We treated the patients without changing the dialysate, and the symptoms improved. Case 1 involved a 68-year-old man complaining of itching. DLST for Carbostar^Ⓡ P solution A was positive. After changing the priming with saline, the symptoms improved. Case 2 involved an 85-year-old man complaining of itching and hives. DLST for Carbostar^Ⓡ P solution B and Lympack TA3^Ⓡ was positive. The symptoms disappeared after changing the priming with saline and a smaller dialysis membrane. We investigated the characteristics of five other cases with positive DLST for dialysate. Three had fever. The fever in Case 3 did not improve because of the presence of a tumor. Case 4 showed a false-positive result for DLST. In Case 5, the fever improved on changing the dialysate. Four cases showed CRP elevation, and only one had an increased eosinophil count. We should test dialysate with DLST if allergy is suspected.