SHM Converge Scientific Abstract ePoster Gallery-Lights Out in the Dialysis Center: A Case of Ethylene Oxide Allergy

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This case describes a 79-year-old dialysis-dependent man who had recurrent hypotensive syncopal episodes at the start of outpatient hemodialysis sessions. Each time dialysis was stopped, he rapidly regained consciousness and returned to baseline. Initial evaluation was unrevealing, including normal physical exam, routine labs, echocardiogram, EKG, head CT, carotid ultrasound, and orthostatic vitals.<br /><br />After beta-blocker therapy was held without improvement, further testing showed marked leukocytosis and severe eosinophilia, prompting treatment with antihistamines for a presumed allergic process. However, syncope recurred and the patient eventually missed over a week of dialysis, developing pulmonary edema and hypoxia from volume overload. A bone marrow biopsy was performed to exclude a primary hematologic disorder. The patient then received prednisone, which successfully allowed completion of dialysis with stable hemodynamics and 2.5 L of fluid removal.<br /><br />Subsequent testing showed highly elevated anti-ethylene oxide IgE, identifying the likely cause as ethylene oxide allergy. Ethylene oxide is commonly used to sterilize dialysis equipment and can trigger hypersensitivity reactions in susceptible patients. The patient later transitioned successfully from prednisone to omalizumab, an anti-IgE therapy, for longer-term management.<br /><br />The case highlights that intradialytic hypotension and syncope have a broad differential diagnosis and that eosinophilia may point to an allergic reaction to dialysis circuit components, including ethylene oxide. Short-term prednisone is an effective treatment in reported cases, while long-term management options remain less established. Regular monitoring of eosinophil levels may help identify dialysis-related hypersensitivity as a cause of unexplained intradialytic symptoms.

Asset Subtitle

Sophie L. Goemans

Meta Tag

Author List Kevin Krcmarik, Sophie L. Goemans, Steven D. Ma, Sukhdeep Khurana

Category Clinical Vignettes

Concept Intradialytic Hypotension

Concept Ethylene Oxide

Concept Dialysis-Associated Ethylene Oxide Allergy

Concept Syncope

Concept Eosinophilia

Distinguished Non-Finalist

Presenter Organization University of California, San Diego

Presenting Author Sophie L. Goemans

Track Adult

Keywords

hemodialysis

intradialytic hypotension

syncope

eosinophilia

ethylene oxide allergy

dialysis hypersensitivity

prednisone

omalizumab

anti-IgE

volume overload

Intradialytic Hypotension

Ethylene Oxide

Dialysis-Associated Ethylene Oxide Allergy

Syncope

Eosinophilia