Allergies in Phlebology: A National Survey and Review of Literature

Abstract

Background Type I and type IV hypersensitivity can play an important role in phlebology with potential severe consequences for patients and treatment results.

Methods A review of literature was performed for allergic reactions in patients treated for venous insufficiency and venous leg ulcers (VLU), together with a study in the Dutch and European centre for adverse drug reactions. Besides, we performed a survey among 37 Dutch medical hospitals to investigate the incidence of treatment allergies.

Results Hypersensitivity reaction is seen in 46–76% of patient with VLU; about 20% of these reactions are caused by wound dressings products.
In 11 centres urticarial and respiratory complaints were seen and 3 systemic allergic reactions in phlebological treatments. In Europe 25 cases of systemic reactions were reported.

Conclusion Patients with VLU with slow healing tendency should undergo allergy tests. Type I hypersensitivity with anaphylactic reaction, also to sclerosing fluid or tumescent, is very rare.

Zusammenfassung

Hintergrund Typ-I- und Typ-IV-Überempfindlichkeitsreaktionen können in der Phlebologie eine wichtige Rolle spielen, möglicherweise mit schwerwiegenden Folgen für die Patient*innen. Sie können einen negativen Einfluss auf die Behandlungsergebnisse haben.

Methode Es wurde eine Literatursuche nach Suchtermen für allergische Reaktionen bei Patient*innen, die wegen venöser Insuffizienz und venösem Ulcus cruris (VLU) behandelt wurden, in Zusammenarbeit mit dem niederländischen und europäischen Zentrum für unerwünschte Arzneimittelwirkungen durchgeführt. Außerdem führten wir eine Umfrage unter 37 niederländischen Krankenhäusern durch, um die Inzidenz der Behandlung von Allergien zu bestimmen.

Ergebnisse Eine Überempfindlichkeitsreaktion wird bei 46–76% der Patient*innen mit VLU beobachtet, ca. 20% dieser Reaktionen werden durch Wundauflagen verursacht. In 11 Zentren wurden urtikarielle und respiratorische Beschwerden und 3 systemische allergische Reaktionen bei phlebologischen Behandlungen beobachtet. In Europa wurden 25 Fälle von systemischen Reaktionen gemeldet.

Schlussfolgerung Patient*innen mit VLU mit langsamer Heilungstendenz sollten sich Allergietests unterziehen. Eine Typ-I-Überempfindlichkeit mit anaphylaktischer Reaktion, auch auf sklerosierende Flüssigkeit oder Tumeszenz, ist sehr selten.

Schlüsselwörter

Allergie - Überempfindlichkeit - Varikosis - Ulcus cruris venosum - Polidocanol

Keywords

allergy - hypersensitivity - varicose veins - venous leg ulcers - polidocanol

Publication History

Article published online:
17 October 2022

• References

• 1 Valois A, Waton J, Avenel-Audran M. et al. Contact sensitization to modern dressings: a multicentre study on 354 patients with chronic leg ulcers. Contact dermatitis 2015; 72: 90-6
• 2 Machet L, Couhé C, Perrinaeud A. et al. A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975–2003 data. Br J Dermatol 2004; 150: 929-935
• 3 Yiannakopoulou E. Safety Concerns for Sclerotherapy of Telangiectases, Reticular and Varicose Veins. Pharmacology 2016; 98: 62-69
• 4 Eudravigilance. Accessed October 20, 2020 at: www.ema.europa.eu
• 5 Maessen-Visch MB, Van Montfrans C. Wound dressing, does it matter and why?. Phlebology 2016; 31: 63-67
• 6 Singal N, Kar S, Srinivas CR. et al. Effect of allergic contact dermatitis on wound healing. Contact dermatitis 1995; 32: 47-48
• 7 Roitt's essential immunology. Delves PJ, Martin SJ, Burton DR, Roitt IM. Chichester, West Sussex: John Wiley & Sons; 2017
• 8 O'Donnell TF, Eaddy M, Raju A. et al. Assessment of thrombotic adverse events and treatment patterns associated with varicose vein treatment. Surg Venous Lymphat Disord 2015; 3: 27-34
• 9 Coleridge Smith P. Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology 2009; 24: 260-269
• 10 Uter W, Werfel T, White IR. et al. Contact allergy: a review of current problems from a clinical perspective. Int J Environ Res Public Health 2018; 15: 1108
• 11 Mowad C., Anderson B, Scheinman P. et al. Allergic contact dermatitis: Patient diagnosis and evaluation. J Am Acad Dermatol 2016; 74: 1029-1040
• 12 Malten KE, Kuiper JP, van de Staak WBJM. Contact allergic investigations in 100 patients with ulcus cruris. Dermatologica 1973; 7: 238
• 13 Tavadia S, Bianchi J, Dawe S. et al. Allergic contact dermatitis in venous leg ulcer patients. Contact Dermatitis 2003; 48: 261-265
• 14 Malten KE, Kuiper JP. Contact allergic reactions in 100 selected patients with ulcus cruris. Vasa 1985; 14: 340-345
• 15 Smart V, Alavi A, Coutts P. et al. Contact allergens in persons with leg ulcers: a Canadian study in contact sensitization. Int J Lower Extremity Wounds 2008; 7: 120-125
• 16 Barbaud A, Collet E, Le Coz CJ. et al. Contact allergy in chronic leg ulcers: results of a multicentre study carried out in 423 patients and proposal for an updated series of patch tests. Contact dermatitis 2009; 60: 279-287
• 17 Rai R, Shenoy MM, Viswanath V. et al. Contact sensitivity in patients with venous leg ulcer: a multi-centric Indian Study. Int Wound J 2018; 15: 618-622
• 18 Raudonis T, Vankeviciute RA, Lideikaite A. et al. Contact sensitization in patients with chronic leg ulcers: results of a 5-year retrospective analysis. Av Skin & Wound Care 2019; 32: 558-562
• 19 Goldman MP, Guex J. Mechanism of action of sclerotherapy. In: Goldman MP, Weiss RA. Sclerotherapy: Treatment of varicose and teleangiectatic leg veins. Elsevier; 2017: 173-199
• 20 Stricker BH, Oijen JA, Kroon C. et al. Anaphylaxis Following Use of Polidocanol. Ned Tijdschr Geneeskd 1990; 134: 240-242
• 21 Lareb databank. Accessed October 26, 2020 at: www.lareb.nl
• 22 Klein JA. The Tumescent Technique for lipo-suction surgery. Am J Cosm Surg 1987; 4: 263-267
• 23 Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg 2009; 35: 1728-1735
• 24 Nyamekye IK. A practical approach to tumescent local anaesthesia in ambulatory endovenous thermal ablation. Phlebology 2019; 34: 238-245
• 25 Kvisselgaard AD, Krøigaard M, Mosbech HF. et al. No cases of perioperative allergy to local anaesthetics in the Danish anaesthesia allergy centre. Acta Anaesthesiol Scan 2017; 61: 149-155
• 26 Tupker RA, Fransen M, van Zuuren EJ. [Suspected Allergy to a Local Anaesthetic: How Often Is Allergy Proven?. ] Ned Tijdschr Geneeskd 2014; 158: A7556
• 27 Gerontopoulou SA, Gloy I, Woitalla-Bruning J. Allergische Reaktion vom Type IV auf Prilocain nach Anwendung von Tumeszenz-Lokalanästhesie – eine seltene Komplikation. Phlebologie 2020; 49: 292-295
• 28 Klein JA, Jeske DR. Estimated Maximal Safe Dosages of Tumescent Lidocaine. Anesth Analg 2016; 122: 1350-1359
• 29 Martínez MA, Ballesteros S, Segura LJ. et al. Reporting a Fatality During Tumescent Liposuction. Forensic Sci Int 2008; 178: e11-e16
• 30 Wright TF, Brunetti GF, Kennedy P. Lidocaine safety after saphenous vein tumescent anesthesia. Phlebology 2019; 34: 683-689
• 31 Gibson K, Minjarez R, Rinehardt E. et al. Frequency and severity of hypersensitivity reactions in patients after VenaSeal cyanoacrylate treatment of superficial venous insufficiency. Phlebology 2019; 35: 337-344
• 32 Park A, Jeong MH, Park CJ. et al. Clinical Features and Management of “Phlebitis-like Abnormal Reaction” After Cyanoacrylate Closure for the Treatment of Incompetent Saphenous Veins. Ann Vasc Surg 2019; 55: 239-245
• 33 Navarro-Triviño FJ, Cuenca-Manteca J, Ruiz-Villaverde R. Allergic contact dermatitis with systemic symptoms caused by VenaSeal. Contact Dermatitis 2020; 82: 185-187