Introduction:
Urticaria is an inflammatory skin disorder that affects the majority of the world population which is characterized by itchy wheals. It can happen due to activation and degranulation of skin mast cells and the release of histamine and other mediators, as well as It can be stimulated by many factors, including medications, allergens, or underlying diseases. Hemodialysis patients are at risk of developing urticaria due to potential allergens encountered during dialysis sessions, such as dialysis membranes or medications. A rare cause of urticaria is Generalized cholinergic heat urticaria is a form of physical urticaria with characteristic wheals of 1–5mm diameter caused by stimuli, which raise the core body temperature such as physical exercise, hot baths, and emotional stress. It is a common cause of urticaria (4–7%) and is often not prevented by antihistamines. How hemodialysis induces a raise in body temperature is not well understood. One hypothesis is that volume depletion during dialysis provokes a peripheral vasoconstriction leading to a reduced dissipation of heat from the skin. In this poster, we present a 55-year-old female with end-stage renal disease (ESRD) secondary to hypertension who developed urticaria during a hemodialysis session.
Methods:
The patient had been undergoing hemodialysis for two years through a left arteriovenous fistula. During the first 15 minutes of the session, she developed a skin rash with itchy wheals on her upper limbs, soon it spread to involve her trunk, and it was associated with erythema. The patient was given chlorpheniramine and hydrocortisone to relieve the symptoms. Despite this treatment, the symptoms persisted, leading to the cessation of her dialysis session prematurely, and the patient was transferred to the emergency department for further evaluation.
Results:
Investigations were conducted to determine the underlying cause of the allergic reaction, including reviewing dialysate components, patient medications, and potential allergens. Where patient was recently on Elisio 19H dialyzer, After the urticaria episode, the dialyzer was changed to Solace 19H dialyzer with no further urticaria reaction noted. That’s why a collaboration of multidisciplinary team is needed, for prevention in dealing with such cases in the future.
Conclusions:
This case shed light on the circumstances of urticaria in hemodialysis patients and the challenges in controlling and dealing with allergic reactions. To prevent any further complications immediate recognition and intervention are required. The continuation of symptoms despite antihistamine and corticosteroid treatment suggests that comprehensive investigations should be taken to identify potential triggers in dialysis settings.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.