Abstract
<h3>Introduction</h3> Hypersensitivity reactions dependent not only on IgE during hemodialysis there are more reported and frequently in patients dialyzed with biocompatible polysulfone or polyethersulfone membranes in absence of other risk factors. Describing multiple pathogenic mechanisms. We present the diagnostic approach to a pediatric patient with clinical manifestations of hypersensitivity during hemodialysis. <h3>Case Description</h3> Nine-year-old male with history of myelomeningocele corrected at ten days of life. Currently with stage V chronic kidney disease, bilateral hydronephrosis and neurogenic bladder, requiring intermittent treatment with peritoneal dialysis. February 2022, started hemodialysis and during third session, presented urticaria, angioedema, pruritus, and dyspnea within 30 minutes. Session was suspended and antihistamine administered, without new or different medications to those used in previous sessions. Next session, was premedicated with antihistamine and intravenous steroid, which within 5 minutes of onset presented same symptoms, hemodialysis was stopped and symptoms decreased with the application of antihistamine, changing to cellulose triacetate membrane, allowing to continue hemodialysis in subsequent sessions without new events. <h3>Discussion</h3> The approach to the patient with symptoms of hypersensitivity during hemodialysis represents a diagnostic challenge due to polypharmacy and the difficulty of identifying the causal agent. Associated hypersensitivity reactions, anaphylactic associated or not with IgE, are related to equipment sterilized with ethylene oxide (EtO), polysulfone or cellulose membrane, and drugs. Reactions generally present as acute events with symptoms such as erythema, pruritus, angioedema, pain, and dyspnea. The importance of knowing these reactions helps to create diagnostic protocols and paraclinical tools to search for the causal agent.
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