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To the Editor, Therapeutic plasma exchange (TPE) is a procedure for removing antibodies and toxic metabolites from the plasma.[1] Although TPE is generally regarded as a safe procedure, TPE-related allergic reactions (ARs) occur commonly, at a frequency of 1.4%-12.0%.[[2]] TPE-related ARs vary from mild discomfort to severe and lethal events such as anaphylaxis.[[1]] Nevertheless, the need for a TPE-related AR prophylaxis has not been well studied, and pretreatments for preventing these complications are not routinely recommended.[4] In this study, we aimed to identify the risk factors for TPE-related ARs and to determine whether pretreatments targeting these risk factors could reduce the incidence of these adverse events. This was based on previous evidence that TPE-related ARs occur more frequently when FFP, rather than albumin, is used as the replacement fluid.[2] Risk factor analysis for TPE-related ARs was conducted using logistic regression. Because the allergy history of the patient was a newly identified risk factor, pretreatment for AR prevention was initiated at our hospital from May 1, 2017, for any TPE patients with a history of allergy or in whom FFP was used as the replacement fluid (Figure S1). In conclusion, selective pretreatment of patients undergoing TPE after the identification of risk factors for TPE-related ARs is effective in reducing these complications, in contrast to previous beliefs that pretreatment is unnecessary. [Extracted from the article]