Hypersensitivity reactions during haemodialysis: the choice of methods and assays.

Our considerations about assays to assess agents and mechanisms involved in hypersensitivity reactions can be summarized as follows. The measurement of total IgE is recommended since it confirms a history of atopy of the patient and is a quick and inexpensive laboratory assay. If, based on the anamnesis, a particular allergen can be suspected to be involved in the clinical reaction a RAST against this compound is highly recommended. In any case of a severe clinical reaction the RAST against ethylene oxide is mandatory to confirm or exclude the involvement of ethylene oxide. The radioallergosorbent test (RAST) should not be used as a screening test for an entirely unknown allergen. The determination of histamine in plasma samples can be applied for specific scientific questions but cannot be recommended as a routine test with first priority. In contrast, the measurement of bradykinin should be established as soon as possible as a routine test for all new materials which are developed for application in the extracorporeal circuit. An initiative of the haemodialysis community is recommended to assure the commercial availability of a reliable bradykinin immunoassay.