Risk factors for allergic reaction at initial therapeutic plasma exchange in a single-center study: beware of high rates of severe allergic reaction

Background: Therapeutic plasma exchange (TPE) is an important treatment modality for various diseases, but its use can be restricted by allergic reactions (AR). The aim of our study was to elucidate the frequency of and risk factors for AR at initial TPE using fresh frozen plasma (FFP). Methods: Presences of AR were extracted from the medical records of consecutive patients receiving TPE from 2002 to 2012. The following data at initial TPE were retrieved: age, gender, history of allergy, steroid use, timing of steroid use, mean steroid dose, immunosuppressant use, indication for TPE, and laboratory data. Results: Eighty-eight patients (median age 57 years) underwent TPE, and 28% had an episode of AR. Younger age (odds ratio (OR), 1.04 (95% CI, 1.01–1.08)) and indications other than hepatic insufficiency (OR, 17.8 (95% CI, 1.95–429.4)) were associated with higher incidence of AR. Conclusions: Close observation for AR may be warranted at initial TPE for these conditions.