Dialyzer first use reaction with polysulfone membrane: Moving beyond ethylene oxide

Acute anaphylactic/anaphylactoid reactions to dialyzers are uncommon. Indeed, they are thought to have decreased in incidence since the transition to more biocompatible dialyzer membranes and with the abandonment of ethylene oxide for sterilization of dialyzers. However, few recent Spanish studies suggest that the incidence actually remains the same. Here, we report two cases of dialyzer first use reactions that occurred with polysulfone dialyzers. These were not ethylene oxide sterilized dialyzers and the reactions were less intense/absent from the second reuse onwards. Both the patients were successfully dialyzed by switching to a cellulose triacetate dialyzer or by using a preprocessed dialyzer filled with renalin. Thus, the cause of the reaction could either be the primary polysulfone membrane or a leachable substance from the dialyzer