Re: Allergy to Heparin used in hemodialysis

June 5, 2004

There are some no heparin protocols for the very few people who can't

tolerate heparin. However, did they consider allergy to the dialyzer itself?

An allergic reaction like hives could be that. Some people have an

asthma-like attack (and resulting panic from not being able to breathe

right). There are a number of special dialyzers that are not sterilized with

chemicals, because allergy or reaction to the residue is not uncommon. They

cost more, so dialysis centres don't use them unless they really have to (I

would be inclined to say " cheap ^#$*@# " , but that wouldn't be nice. Your

doctor and the nurses should know about that.

Now, if it was just around the needle insertion sites, on that arm, I would

also suspect allergy to the metal needles themselves (in which case they

could use the plastic " angios " (again, about five times more expensive, so

the nurses are told not to use those unless it's absolutely necessary).

Another possibility there is simply skin that can't handle the stuff in the

little pads they use to clean and sterilize the needle site before needling

(I forget what it's called). If that's the case, they should be able to use

Betadine on you, which is the reddish-brown liquid stuff.

I hope it gets sorted out for you soon. That must feel pretty miserable.

BTW, hydrocortisone cream should not be used for any length of time over

your fistula, because it tends to thin the skin.

If all else fails, you could always consider switching to peritoneal

dialysis. No heparin is needed for that.

Pierre

Allergy to Heparin used in hemodialysis

> Is this discussed before on the list? Any thoughts?

> I suspect that I might be suffering from this.

> Thanks! My case below has too many details for most

> members to read. Please skip if you like.

> Ken

>

> I started hemodialysis in late January 2004. The

> first symptom was high anxiety after dialysis and hard

> to sleep that night. This first symptom persisted and

> can be described more explicitly as " rash all ever the

> body and my lower arm used for dialysis access. It is

> a needle sensation. Many, many small blisters can be

> seen in pink rash areas. The nurse told me to apply

> Hydrocortisone 1% cream. On April 5, my primary care

> doc gave me Hydrocortisone 3% cream and told me not to

> take hot however that can dry skin. On May 11, during

> my visit to my kidney doc, blisters covered all along

> my access area. By mid-May, the blisters leaks fluid

> (from scratching with both clothes and my

> scratching)... Th4e fluid would dry up and became

> scaling. It looked like snake skin. The nurse could

> not find a good place to put needles on my lower left

> arm. The lower arm was swollen, red, and covered with

> blisters all 360 degrees around. Many attempts to put

> needles in ended up with clogs in the needle.

> Unfortunately for me, my kidney doc was on vacation at

> this time. A Dermatologist prescribed me prednisone

> and antibiotics to suppress the skin problem, along

> with 2 body and 1 face creams. Yes, rashes existed at

> face, neck and even ears. In a week, the scaling and

> blisters along access area cleared up. During this

> week, my dialysis did not use Heparin. It always

> clogged up after about 2 hours of use and flashing at

> every 30 minutes with saline. No itching or needle

> sensations. No new blisters. Body rashes were

> hearing.

> Yesterday, the nurse ordered reduced Heparin. (About

> 30% of my regular amount). Good news is that the

> artificial kidney does not clog. The bad news is that

> the rash and needle sensation are back, with some new

> blisters all over my body. The nurse tried it because

> it was too much trouble to do dialysis and spend 2

> filters in a session. Also, she suspected that the

> change might be due to Prednisone and antibiotics, not

> " no Heparin " . The suspicion might be false because

> yesterday was my 11th day on 16-day prednisone

> schedule and the last antibiotics day.

> Before no Heparin, we tried from pork based to beef

> based Heparin without apparent difference to me. For

> the lower arm area, there were suspicions about

> allergy to soup and alcohol

>

June 5, 2004