{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:46:28Z","timestamp":1792813588518,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Lipoprotein apheresis (LA) tolerability is a key factor for the utilization of this therapy. Common reactions to LA are hypotension and nausea. Serious reactions include severe hypotension and anaphylactoid reactions (0.13%\u20101.3% and 0.2%\u20100.4%, respectively). The bradykinin response drives these reactions and can worsen with the use of angiotensin\u2010converting\u2010enzyme inhibitors. Efforts to mitigate these reactions are necessary for the tolerability of LA with a dextran sulfate\u2010adsorption (DSA) system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>In an effort to increase apheresis tolerability, seven patients at The University of Kansas, Department of Clinical Pharmacology, who had prior anaphylactoid reactions (defined as general cutaneous flushing, nausea\/vomiting, tongue swelling, lightheadedness, and hypotension) to the DSA despite pharmacologic intervention, were treated with pre\u2010LA intravenous magnesium adapted from a protocol developed by co\u2010author Eliaz. This protocol consists of 1.5\u00a0g of magnesium sulfate administered over 45\u2009minutes. All seven patients were treated with intravenous magnesium sulfate immediately before LA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No episodes of anaphylactoid reactions during LA have been reported to date.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Magnesium infusion before DSA can be utilized to establish tolerability in patients with prior anaphylactoid reactions to LA. Proposed mechanisms include temporary stabilization of the negative\u2010positive interactions of the dextran sulfate filter leading to a reduction of circulating bradykinin, reduction of nitric oxide, and reduction of the sympathetic response to LA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jca.21884","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T18:21:41Z","timestamp":1613845301000},"page":"437-442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Establishing low\u2010density lipoprotein apheresis tolerability in patients with prior anaphylactoid reactions to lipoprotein apheresis using magnesium sulfate"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4481-9312","authenticated-orcid":false,"given":"Ethan","family":"Alexander","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology University of Kansas School of Medicine  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M.","family":"Moriarty","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology University of Kansas School of Medicine  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Wilk","sequence":"additional","affiliation":[{"name":"Eliaz Therapeutics  Santa Rosa California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7935-2038","authenticated-orcid":false,"given":"Isaac","family":"Eliaz","sequence":"additional","affiliation":[{"name":"Eliaz Therapeutics  Santa Rosa California USA"},{"name":"Amitabha Medical Center  Santa Rosa California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21705"},{"key":"e_1_2_8_3_1","unstructured":"FDA approval.https:\/\/www.fda.gov\/downloads\/Drugs\/DevelopmentApprovalProcess\/UCM071436.pdf. 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