Ethylene oxide

Code: k78
Allergen: Ethylene oxide conjugated to a human serumalbumin (HSA) carrier.
 
Certain protein allergens and chemicals capable of acting as haptens occur at high concentrations in workplace environments. They represent a significant sensitization risk also for less atopic individuals due to their often high concentration in the air.

Allergen Exposure

Ethylene oxide is commonly used industrially for sterilisation of heat sensitive medical devices.
 
Unexpected exposure
Patients undergoing chronic haemodialysis and those exposed to tubings, syringes and other material sterilised with ethylene oxide.
 
Environment
Any workplace where ethylene oxide is used in significant amounts. Certain medical wards.

Clinical Experience

IgE-mediated reactions
Severe allergic symptoms rhinitis, asthma, chest oppression, and urticaria and even anaphylaxis triggered by IgE antibodies to ethylene oxide (1-2) have been reported (3-4). IgE-mediated anaphylaxis mediated by ethylene oxide has been published in patients regularly undergoing haemodialysis and approximately 10% of such patients have been found to have IgE antibodies to ethylene oxide (5-6).

References

  1. Dolovich J, Bell B : Allergy to a product(s) of ethylene oxide gas, demonstration of IgE and IgG antibodies and hapten specificity. J Allergy Clin Immunol 1978, 62, 30-32.
  2. Wass U, Belin L, Delin K: Longitudinal study of specific IgE and IgG antibodies in a patient sensitized to ethylene oxide through dialysis. J Allergy Clin Immunol 1988, 82, 679-85.
  3. Nicholls AJ, Platts MM: Anaphylactoid reactions due to haemodialysis, haemofiltration, or membrane plasma separation. BMJ 1982, 285, 1607.
  4. Poothullil J, Shimizu A, Day RP, Dolovich J: Anaphylaxis from the product(s) of ethylene oxide gas. Ann Intern Med 1975, 82, 58-60.
  5. Marshall C, Pearson F, Shimizu A, Smith EKM, Dolovich J: Sensitization to ethylene oxide in hemodialysis patients. J Allergy Clin Immunol 1984, 73, 164.
  6. Marshall CP, Pearson FC, Sagona MA, Lee W, Wathen RL, Ward RA, Dolovich J: Reactions during hemodialysis caused by allergy to ethylene oxide gas sterilization. J Allergy Clin Immunol 1985, 75, 563-567.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.