PERSISTENT PRURITUS AFTER HYDROXYETHYL ST ARCH INFUSION THERAPY - RETROSPECTIVE LONG-TERM STUDY IN 266 CASES

In 266 patients receiving hydroxyethyl starch (HES) for otological ind ications, we retrospectively analysed the incidence of pruritus and it s relationship to clinical and therapeutic parameters. We found that 3 2% of the patients developed pruritus, which characteristically appear ed as pruritic crises. In 55% of pruritic patients onset after the HES medication had already been discontinued was reported. The symptoms p ersisted on average for 8.8 weeks. Pruritus was generalized, but with a predilection for the trunk and genitalia. Coincidental atopic diseas e or higher age did not promote pruritis. However, the incidence of pr uritus correlated well with the cumulative dosage and also depended on the type and molecular weight of HES given (6% or 10%, mol.wt. 40 or 200 kDa). Light and electron microscopic assessment showed deposits of HES, especially within dermal macrophages and endothelial cells and a djacent to nerve fibres. Pathogenetically a histamine-independent path way is probably responsible for the induction of pruritus. Hence, clas sic antihistaminic drugs had no therapeutic effect in our patients.