IgE Against Ethylene Oxide‐Altered Human Serum Albumin (ETO‐HSA) as an Etiologic Agent in Allergic Reactions of Hemodialysis Patients

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Abstract
Ethylene oxide (ETO) is used to sterilize hemodialyzers and other medical equipment. In an attempt to confirm a link between ETO and hypersensitivity reactions during hemodialysis (HD) we quantitated IgE and total antibody directed against ETO‐altered human serum albumin (ETO‐HSA) in the sera of 65 hemodialysis patients. In 24 patients who had experienced anaphylaxis during HD. the levels of IgE and total antibody against ETO‐HSA were significantly higher than the corresponding levels in 41 patients who had not. Our data demonstrate an association between the presence of IgE and total antibody against ETO‐HSA and immediate anaphylactic reactions to HD. In further studies we characterized the ETO‐HSA antigen by Immunoelectrophoresis, gel filtration chromatography, and cross‐inhibition immunoassay. Our results suggested that ETO gas can alter HSA and induce new antigenic determinants on the molecule. Recently, we encountered a peritoneal dialysis patient with rash and eosinophilia. Suspecting ETO allergy, we measured serum IgE and total antibody to ETO‐HSA and found both to be present. The data suggest that, in addition to the familiar HD reactions, ETO sensitization might cause other allergic diseases as well.