Uneventful plasma exchange with albumin replacement in a patient with a previous anaphylactoid reaction to albumin

A patient who had a previous anaphylactoid reaction to albumin required plasma exchange for myasthenia gravis. She was rechallenged with albumin from a different manufacturer after premedication with diphenhydramine. No adverse reaction occurred during five exchanges over a 10-day period. Possible pathogenic mechanisms and prevention of such reactions are discussed.