Donor deferral for allergic symptoms?

On June 13th, 2000, a member requested input for the following problem: "We deferred a regular donor recently because of active acute allergy symptoms (watery eyes, runny nose, puffy face, etc.). He was incensed. Are there any standard or at least common criteria for donors with allergy symptoms? Should we be concerned about histamine, etc."?

To which the following replies were received:

1. I do not believe that the donor in question had a reason for deferral. First of all, it is not going to harm the donor to donate and second, it is not going to harm the recipient to get the donated blood. In this day and age I think we best figure ways to take donors that appear to donate and not try to figure out ways to defer all of them!
   
   
2. Our Center's SOP manual specifies the following:

If the donor has allergic rhinitis characterized by runny nose, sneezing, and tearing of the eyes associated with allergies:

• For Allogeneic donation - TEMPORARY DEFERRAL if associated with fever, purulent (thick yellow or green) nasal drainage, or antibiotic therapy. ACCEPT if asymptomatic, or with runny nose, sneezing or watery eye related to the allergy.
• For Autologous donation - same as allogeneic.

If donor has an allergy, defined as an acquired hypersensitivity to a particular substance.

• For Allogeneic donation - TEMPORARY DEFERRAL if associated with fever, purulent (thick yellow or green) nasal drainage, or antibiotic therapy. ACCEPT if asymptomatic, or with runny nose, sneezing or watery eyes related to the allergy.
• For Autologous donation - TEMPORARY DEFERRAL if associated with fever, purulent (thick yellow or green) nasal drainage, or antibiotic therapy. ACCEPT if asymptomatic, or with runny nose, sneezing or watery eye related to the allergy.

3. I don't believe that there are any specific standards that speak to the acceptability of a donor with allergic symptoms. Therefore, medical judgment would determine suitability to donate. If one can be reasonably sure that there is not an infectious process underlying the allergic symptoms (e.g. sinusitis) and if the donor is not taking a medication that would disqualify them, then I would accept the donor. I would not worry about histamines and other mediators of the allergic response.
   
   
4. We do not worry about the allergy per se. Someone having the sort of allergic reaction characterized by localized symptoms is not having a systemic problem. The key for us is differentiating simple allergy from infection and our follow-up questions to the donor would be about fever, sore throat, productive cough, etc.
   
   
5. In the Central Valley, where 80% of the adult population has allergies, we generally accept donors with allergy symptoms, as long there is no reason to suspect superimposed infection (fever, yellow or green discharge, etc). In this case, we will defer until treatment is completed and infection symptoms are no longer present. If donor took antibiotics, we defer for 48 hours after the last dose.
   
   
6. We do have criteria regarding allergy symptoms. We would not defer this particular donor. According to our criteria, a donor is eligible as long as he/she does not have "severe" allergy symptoms (shortness of breath, wheezing, respiratory difficulty or systemic rash) within the previous 24 hours. Our criteria is based upon donor risk not patient risk associated with histamine.
   
   
7. I believe you will find that blood centers differ widely in their acceptance criteria for donors with the symptoms you describe. Our nurses feel it's very rare that donors present with severe symptoms. Most with allergies are taking one of the newer medications, like Claritin or Allegra. We don't defer for mild allergy symptoms or for allergy shots. If the donor presents with severe symptoms, the medical historian would question carefully, might contact the Medical Director for authorization to accept the donor, and would probably defer the donor until s/he is feeling better. In my past life at a large regional blood center, I recall that we deferred a few days (or until symptoms were clear) because of (1) concerns about histamines and (2) difficulty in differentiating between allergy and upper respiratory infection. We did not defer if the donor's symptoms were controlled by an antihistamine; in fact we encouraged donors with allergy problems to stay on their medication. I seem to recall that we also deferred a few days for allergy desensitization injections.
   
   
8. I generally do not make a big issue out of seasonal allergies in regard to blood donation. As long as the donor is otherwise feeling OK, and feels well enough to donate, I think they are acceptable. I do not feel that IgE levels, etc., are a significant issue in the typical case of "hay fever." Now, if the donor is having a significant allergic reaction manifested by hives, maculopapular rash, wheezing, etc., I think that is different from the person with a typical seasonal allergy and IgE may be an issue in this case. However, I think the issue of "hay fever" and seasonal allergies is deserving of further study, and it would not surprise me that a fair number of transfusion recipients who experience allergic manifestations, do so because of some allergen in the donor. Several years ago a couple of abstracts were presented at ASH (by Kaaron Benson, MD, from Tampa, FL) of two transfusion recipients who experienced allergic manifestations and a "lookback" of the donors revealed that one donor had eaten seafood within the previous 24 hours (and that recipient was allergic to shellfish), and the other donor had cats (and that recipient was allergic to cats). Probably one of the first documented reports of an allergic reaction to transfusion was published in JAMA in the early 1900's and involved a recipient who was severely allergic to horses and the donor had been around horses just prior to donation and transferred the horse allergen to the recipient. These allergic cases/concerns are different than that concerning hay fever and seasonal allergy. Bottom line, it would take a lot for me to defer a donor because of seasonal allergy symptoms.
   
   
9. We accept donors who have allergies if they are capable of answering the question regarding whether they feel well on the day of donation. If they have recurrent allergies but don't feel poorly on the day of donation, we allow them to donate. If there is a question regarding a possible infectious etiology of the donor's symptoms, then we defer the donor until their symptoms have abated.
   
   
10. Our criteria for donors allows donors with "stuffy nose, itchy eyes and irritated throat due to sinus or allergy conditions" to donate.
    
    
11. If a donor came to donate with active acute allergy symptoms we would not accept him/her, either. There is no uniform standard with regards to allergies and blood donation, but there have been reports of passive transfer of antibodies, and each blood center's Medical Director is able to make his/her own decision on this issue.
    
    
12. Editor's Note: Well, as you can see, there is a majority opinion, but not a unanimous opinion regarding when to defer or accept donors who have active acute allergy symptoms.

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