Ethylene oxide (EtO) allergy to EtO gas-sterilized needles in a patient on maintenance hemodialysis (HD)

We report a maintenance HD patient with allergy to EtO-sterilized needles. A 61-year-old man with chronic glomerulonephritis started on maintenance HD in January 1989. He began to have itching and swelling of the puncture sites of the arterio-venous fistula with eosinophilia in 1990. We suspected that the symptoms might be caused by allergy to povidone iodine or chlorhexidine digluconate, which were used to sterilize the puncture sites. Although we changed the puncture site, the same symptoms appeared at the new puncture site. In addition to eosinophilia, the serum level of total IgE elevated, and the IgE was EtO specific. On the basis of these findings, it was suspected that the symptoms were due to allergy to EtO-sterilized needles. After the needles were changed to autoclaved ones, his symptoms and eosinophilia completely disappeared. Since currently dialysis equipment is almost always autoclaved or gamma-ray sterilized, HD patients with EtO allergy have decreased. However, we should be alert to allergy to EtO like this case, because needles and catheters are still mainly sterilized with EtO.