Pruritus precipitated by hydroxyethyl starch: a review

@article{Bork2005PruritusPB,
  title={Pruritus precipitated by hydroxyethyl starch: a review},
  author={Konrad Bork},
  journal={British Journal of Dermatology},
  year={2005},
  volume={152}
}
  • K. Bork
  • Published 1 January 2005
  • Medicine
  • British Journal of Dermatology
Hydroxyethyl starch (HES) is widely used for fluid management in broad populations of patients, particularly in the surgery and intensive care settings. Pruritus, often manifested as pruritic crises, is increasingly being recognized as a common major adverse effect of HES administration. This iatrogenic form of pruritus is frequently severe and protracted with a serious negative impact on patient quality of life, including sleep disturbance, disruption of daily routine and mental distress. Such… 
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References

SHOWING 1-10 OF 83 REFERENCES
Persistent pruritus after hydroxyethyl starch infusion therapy: a result of long‐term storage in cutaneous nerves
TLDR
HES deposits in cutaneous nerves, as a consequence of a higher cumulative dosage, may account for the itching seen after HES infusion.
[Persistent pruritus after hydroxyethyl starch infusions. Retrospective long-term study of 266 cases].
TLDR
Pathogenetically a histamine-independent pathway is probably responsible for the induction of pruritus, and classic antihistaminic drugs had no therapeutic effect in patients receiving HES for otological indications.
Lesson of the week: Persistent itching due to etherified starch plasma expander
TLDR
Three cases of pruritus induced by etherified starch after heart surgery that were seen by dermatologists from the authors' department over four months show the importance of considering this diagnosis in patients who developPruritus after major surgery.
Clinical and pathophysiological aspects of hydroxyethyl starch-induced pruritus: evaluation of 96 cases.
TLDR
The findings indicate that pruritus in HES-infused patients is most likely not triggered by pruritogenic mediators, and support data from the recent literature, suggesting a direct stimulation of cutaneous nerves by HES deposits.
[Hydroxyethyl starch accumulation in the skin with special reference to hydroxyethyl starch-associated pruritus].
TLDR
The results emphasize the need for starch derivatives that can be better metabolized and for better adapted infusion schedules to reduce the high incidence of pruritus.
Hydroxyethyl Starches and Pruritus: A Real Problem?
TLDR
Hydroxyethyl starches are widely used as plasma substitutes and deposition of HES in Schwann cells of cutaneous nerves appears a likely mechanism, and antihistaminic drugs are ineffective.
Differential storage of hydroxyethyl starch (HES) in the skin: an immunoelectron-microscopical long-term study
TLDR
To examine precisely the intracellular uptake and long-term storage of HES in the skin, skin biopsies from 119 patients who received HES of various preparations and cumulative dosage were obtained 30 min to 130 months after infusion therapy.
[Itching following therapy with hydroxyethyl starch (HES) in otoneurological diseases].
TLDR
It is suggested therapeutic recommendations should be developed to prevent some patients extremely uncomfortable and socially embarrassing side effects after HES-therapy when given in relatively high doses.
Hydroxyethylstarch deposits in human skin — a model for pruritus?
TLDR
Results indicate that other mediators from HES-affected cells must be responsible for the development of the itching, and investigation of HES storage may be a useful contribution to the elucidation of release of itch mediators and induction of pruritus.
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