Pruritus after haes infusions L29.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Pruritus after hydroxyethyl starch infusions

Definition
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Severe and steady pruritus, which begins 6-8 weeks after infusion therapy with hydroxyethyl starch Duration: up to 2 years. The intensity of itching depends on the dose of hydroxyethyl starch applied. Usually there is no skin finding.

Occurrence/Epidemiology
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In up to 40% of patients, especially in atopic diathesis.

Etiopathogenesis
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It is unclear, but there is a discussion about a longer-term storage of HAES in the reticuloendothelial system.

External therapy
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Causal therapies are not known. The external therapy approaches are generally not very successful. Cooling ointments containing water, shaking mixtures, creams or gels with additions of menthol (menthol-cream 5%) and polidocanol ( R200, R197, Optiderm) are able to slightly reduce itching. Cold showering can also temporarily reduce itching. The efficacy of creams containing nicotinic acid (e.g. Nicodan N or as a formulation(propyl nicotinate ointment 0.1%) has also been reported.

Internal therapy
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No response to glucocorticoids and most antihistamines! Successes with hydroxyzin (Atarax) 3 times/day 25 mg, paracetamol 1-2 g/day in 3-4 ED, naltrexone (nemexin) 50 mg/day p.o. are described.

Literature
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  1. Bork,K (2005) Pruritus precipitated by hydroxyethyl starch: a review. Br J Dermatol 152: 3-12
  2. Hermann J et al (1990) Diagnosis and therapy of persistent pruritus after infusion of hydroxyethyl starch (HÄS). Act Dermatol 16: 166-167
  3. Murphy M et al (2001) The incidence of hydroxyethyl starch-associated pruritus. Br J Dermatol 144: 973-976

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Last updated on: 29.10.2020