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Zhang J, Li J, Liu H, Liu J, Zhao L, Li X, Li X. Relationship between fasting prior to contrast-enhanced CT and adverse reaction in patients with allergies history. Clin Radiol 2024; 79:420-427. [PMID: 38599950 DOI: 10.1016/j.crad.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 04/12/2024]
Abstract
AIM To examine the relationship between fasting prior to contrast-enhanced CT (CECT) and adverse reaction (AR) in patients with allergies history. MATERIALS AND METHODS Patients with allergies history who underwent CECT from January 2014 to December 2020 (713 cases with iodinated contrast media (ICM)-related allergy history and 27045 cases with unrelated allergies history) were retrospectively analyzed. The occurrence of ICM-related AR and patient information were recorded. The relationship between fasting and AR and emetic complications was analyzed. RESULTS There was no statistical difference in the overall incidence of AR and emetic complications between fasting group and non-fasting group (P>0.05) and fasting was not an influence factor for overall AR occurrence in patients with both ICM-related and unrelated allergies history. However, the incidence of severe AR in fasting group was higher than that in non-fasting group (P=0.01) in patients with unrelated allergies history. The AR incidence in fasting group was higher than that in non-fasting group (P=0.022) when receiving abdominal examinations in patients with unrelated allergies history. There was no statistical difference in the incidence of AR with different occurrence time between fasting group and non-fasting group (P>0.05) in patients with both ICM-related and unrelated allergies history. CONCLUSIONS Fasting was associated with higher incidence of severe AR and was associated with higher AR incidence when receiving abdominal examinations in patients with unrelated allergies history. Fasting did not have effects on the occurrence time of AR in patients with allergies history. These provided new guidance for usage of ICM in patients with allergies history.
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Affiliation(s)
- J Zhang
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China; Department of Radiology, Air Force Medical Center, Air Force Medical University, No.30 Fucheng Road, Haidian District, Beijing 100142, China
| | - J Li
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China
| | - H Liu
- Department of Radiology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekou Outer Street, Beijing 100088, China
| | - J Liu
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China
| | - L Zhao
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China
| | - X Li
- Department of Radiology, Air Force Medical Center, Air Force Medical University, No.30 Fucheng Road, Haidian District, Beijing 100142, China.
| | - X Li
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China.
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Fraval A, Mont MA, Parvizi J. Iodine Allergy and the Orthopaedic Patient. J Bone Joint Surg Am 2023; 105:1731-1733. [PMID: 37262181 DOI: 10.2106/jbjs.22.01389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Andrew Fraval
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Fraval A, Zappley N, Hozack WJ. The Use of Iodophor-Impregnated Drapes in Patients With Iodine-Related Allergies: A Case Series and Review of the Literature. Arthroplast Today 2023; 23:101201. [PMID: 37745955 PMCID: PMC10517272 DOI: 10.1016/j.artd.2023.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes. Methods This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor-impregnated drape. Results Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine. Sixteen patients had a cluster of iodine-related allergies. There were no intraoperative reports of an allergic reaction to this drape. There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery. Conclusions Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodiphor impregnated drapes in these patients.
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Affiliation(s)
- Andrew Fraval
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicolina Zappley
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - William J. Hozack
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Guyer AC, Macy E, White AA, Kuruvilla ME, Robison RG, Kumar S, Khan DA, Phillips EJ, Ramsey A, Blumenthal K. Allergy Electronic Health Record Documentation: A 2022 Work Group Report of the AAAAI Adverse Reactions to Drugs, Biologicals, and Latex Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2854-2867. [PMID: 36151034 DOI: 10.1016/j.jaip.2022.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
The allergy section of the electronic health record (EHR) is ideally reviewed and updated by health care workers during routine outpatient visits, emergency room visits, inpatient hospitalizations, and surgical procedures. This EHR section has the potential to help proactively and comprehensively avoid exposures to drugs, contact irritants, foods, and other agents for which, based on an individual's medical history and/or genetics, there is increased risk for adverse outcomes with future exposures. Because clinical decisions are made and clinical decision support is triggered based on allergy details from the EHR, the allergy module needs to provide meaningful, accurate, timely, and comprehensive allergy information. Although the allergy section of the EHR must meet these requirements to guide appropriate clinical decisions and treatment plans, current EHR allergy modules have not achieved this standard. We urge EHR vendors to collaborate with allergists to optimize and modernize allergy documentation. A work group within the Adverse Reactions to Drugs, Biologicals, and Latex Committee of the American Academy of Allergy, Asthma & Immunology was formed to create recommendations for allergy documentation in the EHR. Whereas it is recognized that the term "allergy" is often used incorrectly because most adverse drug reactions (ADRs) are not true immune-mediated hypersensitivity reactions, "allergy" in this article includes allergies and hypersensitivities as well as side effects and intolerances. Our primary objective is to provide guidance for the current state of allergy documentation in the EHR. This guidance includes clarification of the definition of specific ADR types, reconciliation of confirmed ADRs, and removal of disproved or erroneous ADRs. This document includes a proposal for the creation, education, and implementation of a drug allergy labeling system that may allow for more accurate EHR documentation for improved patient safety.
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Affiliation(s)
| | - Eric Macy
- Allergy Department, Kaiser San Diego Medical Center, Permanente Southern California, San Diego, Calif
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - Merin E Kuruvilla
- Division of Pulmonary, Allergy, and Critical Care, Emory University School of Medicine, Atlanta, Ga
| | - Rachel G Robison
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Santhosh Kumar
- Department of Pediatrics, Division of Allergy and Immunology, Virginia Commonwealth University Health Systems, Richmond, Va
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Allison Ramsey
- Rochester Regional Health, Rochester, NY; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass.
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Berlyand Y, Fraga JA, Succi MD, Yun BJ, Lee AHY, Baugh JJ, Whitehead D, Raja AS, Prabhakar AM. Impact of iodinated contrast allergies on emergency department operations. Am J Emerg Med 2022; 61:127-130. [PMID: 36096014 DOI: 10.1016/j.ajem.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Adverse reactions to intravenous (IV) iodinated contrast media are classified by the American College of Radiology (ACR) Manual on Contrast Media as either allergic-like (ALR) or physiologic (PR). Premedication may be beneficial for patients who have prior documented mild or moderate ALR. We sought to perform a retrospective analysis of patients who received computed tomography (CT) imaging in our emergency department (ED) to establish whether listing of an iodinated contrast media allergy results in a delay in care, increases the use of non-contrast studies, and to quantify the incidence of listing iodinated contrast allergies which do not necessitate premedication. METHODS We performed a retrospective analysis of CT scans performed in our academic medical center ED during a 6-month period. There were 12,737 unique patients of whom 454 patients had a listed iodinated contrast allergy. Of these, 106 received IV contrast and were categorized as to whether premedication was necessary. Descriptive statistics were used to evaluate patient demographics, clinical characteristics, and operational outcomes. A multivariate linear regression model was used to predict time from order to start (OTS time) of CT imaging while controlling for co-variates. RESULTS Non-allergic patients underwent contrast-enhanced CT imaging at a significantly higher rate than allergic patients (45.9% vs. 23.3%, p < 0.01). The OTS time for allergic patients who underwent contrast-enhanced CT imaging was 360 min and significantly longer than the OTS time for non-allergic patients who underwent contrast-enhanced CT imaging (118 min, p < 0.001). Of the 106 allergic patients who underwent contrast-enhanced CT imaging, 27 (25.5%) did not meet ACR criteria for necessitating premedication. The average OTS time for these 27 patients was 296 min, significantly longer than the OTS for non-allergic patients (118 min, p < 0.01) and did not differ from the OTS time for the 79 patients who did meet premedication criteria (382 min, p = 0.23). A multivariate linear regression showed that OTS time was significantly longer if a contrast allergy was present (p < 0.001). CONCLUSION A chart-documented iodinated contrast allergy resulted in a significant increase in time to obtain a contrast-enhanced CT study. This delay persisted among patients who did not meet ACR criteria for premedication. Appropriately deferring premedication could potentially reduce the ED length-of-stay by over 4 h for these patients.
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Affiliation(s)
- Yosef Berlyand
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - John Anthony Fraga
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Marc D Succi
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Brian J Yun
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Emergency Medicine, Boston Medical Center, 725 Albany Street, Boston, MA, USA
| | - Andy Hung-Yi Lee
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Joshua J Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - David Whitehead
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Anand M Prabhakar
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA.
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Alshehab NA, Alhumaid MA, Alabdulwahed MA, Almulhim AS. Evaluating pharmacists' knowledge, attitude, and practices toward amiodarone cross-reactivity with iodine: a cross-sectional pilot study. PeerJ 2022; 10:e13665. [PMID: 35833013 PMCID: PMC9272816 DOI: 10.7717/peerj.13665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/10/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction Iodine is a vital mineral of the human body that acts by maintaining the health of the thyroid gland. Research has shown that iodine-rich food allergy (i.e., seafood allergy) is not caused by iodine itself; instead, it is caused by other proteins including tropomyosin and parvalbumin in shellfish and fish, respectively. Amiodarone is a commonly used antiarrhythmic agent containing a significant amount of iodine. Objective This study's objective was to assess pharmacists' knowledge, attitude, and practices toward the misconception of iodine allergy and the cross-reactivity with amiodarone. Methods In February 2020, a cross-sectional study was conducted by sending out an online survey to three pharmaceutical organizations (Saudi Pharmaceutical Society, Kuwait Pharmaceutical Association, and Oman Pharmaceutical Society). Additionally, an electronic questionnaire was administered to pharmacists attending the Dubai International Pharmaceuticals and Technologies Conference and Exhibition 2020 (DUPHAT). Chi-square or Fisher's exact test, when appropriate, were used to compare categorical variables. The statistical analyses were carried out using SPSS software. Results Data were collected from 66 respondents. However, only 61 (92.4%) were included in the final analysis following the exclusion of incomplete responses. The mean age of participants was 35 ± 8.48 years. The majority of participants did not have the Board of Pharmacy Specialties Certification (54.1%). Moreover, (41%) of participants licensed as pharmacists with more than 10 years of initial pharmacy licensure. Forty-three (70.5%) of participants had the misconception that iodine allergy should be considered before amiodarone administration, 20/32 (62.5%) of whom considered iodine allergy alone thought that premedication with corticosteroids and/or antihistamines is necessary. Concerning iodine allergy and amiodarone use, there was no significant difference in knowledge between the pharmacists who have board certification and those who did not. Conclusion Pharmacists' misconception concerning iodine allergy and cross-reactivity with amiodarone was evident. Implementation of educational programs targeting pharmacists is necessary to correct these misconceptions.
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Boehm IB. To crack a nut with a sledgehammer: premedication in a patient with a history of mild symptoms following the injection of a contrast agent. Quant Imaging Med Surg 2022; 12:4005-4006. [PMID: 35782240 PMCID: PMC9246732 DOI: 10.21037/qims-22-256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2023]
Affiliation(s)
- Ingrid B Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
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Chen MY, O’Neill H, Rukin NJ. The Iodine allergy myth: What is contraindicated and alternative options for retrograde pyelography. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415819841953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Y Chen
- Department of Urology, Redcliffe Hospital, Queensland, Australia
- School of Medicine, University of Queensland, Australia
| | - Hailey O’Neill
- Department of Urology, Redcliffe Hospital, Queensland, Australia
| | - Nicholas J Rukin
- Department of Urology, Redcliffe Hospital, Queensland, Australia
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Ruff C, Banayan E, Overdeck D. Patients have very limited knowledge of their contrast allergies. Clin Imaging 2021; 79:319-322. [PMID: 34392072 DOI: 10.1016/j.clinimag.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify patients' knowledge of their iodinated contrast allergies; and to compare this data to literature estimates of patient knowledge of other medication allergies. METHODS Using a key word search of 15,715 patients undergoing a total of 19,043 CT studies over a six-month period, a cohort of 307 adult patients claiming prior allergic reaction to iodinated intravenous contrast was identified. A patient questionnaire with the CT studies inquired about the specifics of their contrast allergy, including the symptoms of their prior allergic reaction; when and where the reaction occurred; and if patients could name the contrast agent to which they claim to be allergic. RESULTS In the cohort of 307 patients claiming a prior allergic reaction to iodinated contrast, 86.6% could describe their prior allergic reaction symptoms. Only 36.8% could provide an approximate year of the reaction, with an additional 6.5% claiming that their reactions were remote, for a total of 43.3% providing some information when their reaction occurred. 56.7% provided no information on the year of their reaction. 40.7% named either the facility or the city where the reaction occurred, while 59.3% could not. Only 5 of 307 (1.6%, p < 0.00001) could name the contrast agent to which they believed they were allergic. CONCLUSION Other studies have reported inconsistencies, limited documentation, and limited ability to confirm patients' pharmacologic allergies, estimating that patients prior to pharmacist consultation are approximately 60-70% accurate in listing their drug allergies by name. Nevertheless, patients' knowledge of their iodinated contrast allergies is markedly more limited when compared to expected patient knowledge of medication allergies in general.
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Affiliation(s)
- Cullen Ruff
- UVA School of Medicine, Fairfax Radiological Centers, 2722 Merrilee Dr., Suite 230, Fairfax, VA 22031, United States of America.
| | - Elliot Banayan
- Virginia Commonwealth University, Fairfax, VA, United States of America
| | - Daniel Overdeck
- Fairfax Radiology Centers, Fairfax, VA, United States of America
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Bansie RD, Karim AF, van Maaren MS, Hermans MA, van Daele PLA, Gerth van Wijk R, Rombach SM. Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review. Int J Immunopathol Pharmacol 2021; 35:20587384211015061. [PMID: 34053316 PMCID: PMC8170298 DOI: 10.1177/20587384211015061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. METHODS A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. RESULTS Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%-9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%-34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. CONCLUSION In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.
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Affiliation(s)
- Rakesh D Bansie
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.,Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - A Faiz Karim
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.,Department of Internal Medicine, Section Allergy and Clinical Immunology, Gouda Groene Hart Ziekenhuis, Zuid-Holland, the Netherlands
| | - Maurits S van Maaren
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Maud Aw Hermans
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Paul LA van Daele
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Saskia M Rombach
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
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Seafood Intake as a Method of Non-Communicable Diseases (NCD) Prevention in Adults. Nutrients 2021; 13:nu13051422. [PMID: 33922600 PMCID: PMC8146377 DOI: 10.3390/nu13051422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022] Open
Abstract
Seafood (fish in particular) is one of the main food groups in nutrition models with proven health benefits. Seafood has long been considered a very valuable dietary component, mainly due to presence of n-3 polyunsaturated fatty acids (n-3 PUFA) but it is also an important source of protein (including collagen), anserine, taurine, iodine, selenium, vitamin A, vitamin K, vitamin D, tocopherols, B vitamins and astaxanthin. Considering the beneficial effects of these ingredients on blood pressure, lipid profile and the inflammatory process, seafood should be an essential component of the diet. Non-communicable diseases (NCD) such as cardiovascular diseases, cancer, diabetes and mental disorder, chronic respiratory diseases are common diseases associated with advanced age. Promotion of a healthy lifestyle (including proper nutritional behavior) and prevention of diseases are the most effective and efficient ways to decrease premature mortality from NCD and to maintain mental health and well-being. This review article shows the potential preventive and therapeutic effects of seafood with an emphasis on fish. Our narrative review presents the results of systematic reviews and meta-analysis.
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Abstract
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The current evidence regarding iodine-containing compounds and iodine allergy cross-reactivity is reviewed. Summary Iodine is an essential human nutrient found in the thyroid gland. It is used in the synthesis of the thyroid hormones thyroxine and triiodothyroxine. Patients who report having adverse reactions to iodine-containing substances are often labelled as having an “iodine allergy,” which can result in delays in care or patients being denied essential ICM or other iodine-containing drugs. A literature review was conducted to evaluate the evidence regarding iodine allergy and iodine-containing drugs. Of 435 articles considered potentially appropriate for full review (plus 12 additional articles included on the basis of references from the eligible articles), 113 could not be obtained. After exclusion of 353 articles that did not meet all inclusion criteria, the remaining 81 articles were included in the review. The results of the literature review indicated that iodine has not been shown to be the allergen responsible for allergic reactions to iodinated contrast media, amiodarone, povidone-iodine, and other iodine-containing compounds. Conclusion There is a lack of evidence to support cross-reactivity between iodine-containing compounds in so called iodine-allergic individuals.
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Affiliation(s)
| | - John Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Amy Choi
- Stanson Health, Charlotte, NC, USA
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Solé D, Spindola MAC, Aun MV, Araújo Azi LMTD, Bernd LAG, Garcia DB, Capelo AV, Cumino DDO, Lacerda AE, Lima LC, Morato EF, Nunes RR, Rubini NDPM, da Silva J, Tardelli MA, Watanabe AS, Curi EF, Sano F. [Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:642-661. [PMID: 33308829 PMCID: PMC9373683 DOI: 10.1016/j.bjan.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.
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Affiliation(s)
- Dirceu Solé
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Maria Anita Costa Spindola
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Marcelo Vivolo Aun
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital Universitário, São Paulo, SP, Brazil
| | - Liana Maria Tôrres de Araújo Azi
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brasil.
| | - Luiz Antonio Guerra Bernd
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daniela Bianchi Garcia
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Hospital Infantil Pequeno Príncipe, Curitiba, PR, Brasil
| | - Albertina Varandas Capelo
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brazil
| | - Débora de Oliveira Cumino
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Hospital Infantil Sabará, São Paulo, SP, Brazil
| | - Alex Eustáquio Lacerda
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Luciana Cavalcanti Lima
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Instituto Medicina Integral Prrofessor Fernando Figueira, Recife, PE, Brazil
| | - Edelton Flávio Morato
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Rogean Rodrigues Nunes
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Hospital Geral de Fortaleza (HGF), Departamento de Anestesia, Fortaleza, CE, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jane da Silva
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Maria Angela Tardelli
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil
| | - Alexandra Sayuri Watanabe
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Erick Freitas Curi
- Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil; Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - Flavio Sano
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Hospital Nipo Brasileiro, São Paulo, SP, Brasil
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Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 33308829 PMCID: PMC9373683 DOI: 10.1016/j.bjane.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.
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15
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Huynh K, Baghdanian AH, Baghdanian AA, Sun DS, Kolli KP, Zagoria RJ. Updated guidelines for intravenous contrast use for CT and MRI. Emerg Radiol 2020; 27:115-126. [PMID: 31925592 DOI: 10.1007/s10140-020-01751-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/03/2020] [Indexed: 12/29/2022]
Abstract
Intravenous (IV) contrast material is used extensively for CT and MRI scans done in emergency departments (ED). Its use is essential to make many critical diagnoses in ED patients. While adverse reactions can occur, newer research has added to our knowledge of IV contrast media tolerance and safety leading to improved and more liberal guidelines for intravenous contrast use. The updated information described in this review article indicates how intravenous contrast can be used safely in more patients, more expeditiously and with fewer precautions than with prior guidelines. This review article explains the basis for the new recommendations for intravenous contrast material use and describes indicated precautions and preparations to avoid adverse reactions for iodinated agents used for CT and gadolinium agents for MRI.
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Affiliation(s)
- Kevin Huynh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Arthur H Baghdanian
- Department of Radiology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Armonde A Baghdanian
- Department of Radiology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Derek S Sun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Ronald J Zagoria
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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Maloney E, Iyer RS, Phillips GS, Menon S, Lee JJ, Callahan MJ. Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions. Pediatr Radiol 2019; 49:433-447. [PMID: 30923875 DOI: 10.1007/s00247-018-4306-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing "yes" responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - John J Lee
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
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17
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The "myth" of iodine allergy to radiocontrast in Emergency Medicine. Am J Emerg Med 2018; 37:1363-1365. [PMID: 30553637 DOI: 10.1016/j.ajem.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 11/23/2022] Open
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18
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Flug JA, Ponce LM, Osborn HH, Jokerst CE. Never Events in Radiology and Strategies to Reduce Preventable Serious Adverse Events. Radiographics 2018; 38:1823-1832. [DOI: 10.1148/rg.2018180036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jonathan A. Flug
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Lisa M. Ponce
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Howard H. Osborn
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Clinton E. Jokerst
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
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19
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Rich K, Treat-Jacobson D, DeVeaux T, Fitzgerald K, Kirk L, Thomson L, Foley A, Hill D. Society for Vascular Nursing-Carotid endarterectomy (CEA) updated nursing clinical practice guideline. JOURNAL OF VASCULAR NURSING 2017; 35:90-111. [PMID: 28527733 DOI: 10.1016/j.jvn.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | - Laura Kirk
- University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Lily Thomson
- Section of Vascular Surgery, Health Sciences Centre, Vascular Research Lab, Winnipeg, Manitoba, Canada
| | - Anne Foley
- Department of Vascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debbie Hill
- Vascular Health Partners, Community Care Physicians, Albany, New York
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20
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Hsu Blatman KS, Hepner DL. Current Knowledge and Management of Hypersensitivity to Perioperative Drugs and Radiocontrast Media. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:587-592. [DOI: 10.1016/j.jaip.2017.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/16/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
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21
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Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, Ellis A, Golden DBK, Greenberger P, Kemp S, Khan D, Ledford D, Lieberman J, Metcalfe D, Nowak-Wegrzyn A, Sicherer S, Wallace D, Blessing-Moore J, Lang D, Portnoy JM, Schuller D, Spector S, Tilles SA. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol 2016; 115:341-84. [PMID: 26505932 DOI: 10.1016/j.anai.2015.07.019] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 12/12/2022]
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Taslakian B, Sebaaly MG, Al-Kutoubi A. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 2: Patient Preparation and Medications). Cardiovasc Intervent Radiol 2015; 39:489-99. [PMID: 26606917 DOI: 10.1007/s00270-015-1239-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023]
Abstract
Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care. Patient care before and after an interventional procedure, identification, and management of early and delayed complications of various procedures are equal in importance to the procedure itself. In this second part, we complete the comprehensive, methodical review of pre-procedural care and patient preparation before vascular and interventional radiology procedures.
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Affiliation(s)
- Bedros Taslakian
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, New York, NY, 10016, USA.
| | - Mikhael Georges Sebaaly
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, PO Box: 11-0236, Lebanon.
| | - Aghiad Al-Kutoubi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, PO Box: 11-0236, Lebanon.
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23
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Stukus DR, Green T, Montandon SV, Wada KJ. Deficits in allergy knowledge among physicians at academic medical centers. Ann Allergy Asthma Immunol 2015; 115:51-55.e1. [PMID: 26024806 DOI: 10.1016/j.anai.2015.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Allergic conditions have high prevalence in the general population. Misconceptions regarding the diagnosis and management of allergic disease among physicians can lead to suboptimal clinical care. OBJECTIVE To determine the extent of allergy-related knowledge deficits among physicians. METHODS Pediatric and internal medicine resident and attending physicians from 2 separate academic medical centers were asked to answer an anonymous electronic survey. Survey questions addressed 7 different allergy content areas. RESULTS Four hundred eight physicians completed surveys (23.9% response rate). Respondents had few correct answers (mean ± SD 1.91 ± 1.43). Pediatric respondents had a larger number of correct answers compared with medicine-trained physicians (P < .001). No individual answered every survey question correctly, and 50 respondents (12.3%) had no correct answer. Three hundred seventy-eight respondents (92.6%) were unable to provide correct answers for at least 50% of survey questions. Level of residency training and prior rotation through an allergy and immunology elective correlated with a larger number of correct responses (P < .01). Only 1 survey question had an overall correct response rate higher than 50% (n = 261, 64%). Correct response rate was lower than 30% for 7 of the 9 possible questions. CONCLUSION There are significant knowledge deficits in many areas of allergy-related content among pediatric and internal medicine physicians and across all levels of training and specialty. Given the prevalence of allergic conditions, the potential implications of a negative impact on clinical care are staggering.
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Affiliation(s)
- David R Stukus
- Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Todd Green
- Division of Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh School of Medicine and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shari V Montandon
- Division of Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh School of Medicine and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kara J Wada
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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24
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Westermann-Clark E, Pepper AN, Talreja N, Lockey RF. Debunking myths about “allergy” to radiocontrast media in an academic institution. Postgrad Med 2015; 127:295-300. [DOI: 10.1080/00325481.2015.1012918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Abstract
Drug-induced anaphylaxis is a common cause of anaphylaxis and a leading cause of fatal anaphylaxis. Antibiotics, radiocontrast, and nonsteroidal anti-inflammatory drugs are commonly implicated drugs. Vocal cord dysfunction can mimic anaphylaxis and is often overlooked. β-Lactams are a common cause of anaphylaxis; however, skin testing and drug challenge can usually determine tolerability of other classes of β-lactams. Nonionic contrast agents cause anaphylaxis less frequently than ionic contrast, and immunoglobulin E-mediated mechanisms may have a role in some of these reactions. Skin testing with radiocontrast may have a role in evaluating patients with anaphylaxis to nonionic contrast.
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Affiliation(s)
- Merin Kuruvilla
- Atlanta ENT, 5555 Peachtree Dunwoody Rd, Suite 125, Atlanta, GA-30342, USA
| | - David A Khan
- Division of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8859, USA.
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26
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Abstract
The radiology suite presents the anesthesia provider with a unique set of challenges such as ionizing radiation, intravascular contrast, magnetic fields, physical separation and barriers from the patient, so-called borrowed space, and the large range of procedures performed. Most of these procedures will continue to be performed without the presence of an anesthesia team but, because of the ever-increasing complexity of the procedures being performed and the increasing comorbidities of patients, the anesthesia provider will likely be called more often to provide care. A thorough understanding of these challenges is essential to providing a safe anesthetic in a difficult environment.
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Scheinfeld MH, Sprayregen S, Jerschow E, Dym RJ. Contrast Is the New Penicillin, and Possibly Worse. J Am Coll Radiol 2014; 12:942-3. [PMID: 25533733 DOI: 10.1016/j.jacr.2014.09.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Meir H Scheinfeld
- Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Seymour Sprayregen
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Elina Jerschow
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - R Joshua Dym
- Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Abstract
Contrast-induced nephropathy is an iatrogenic disease caused by the administration of iodinated contrast material to certain at-risk patients. The clinical features include renal failure, with oliguria, anuria, and electrolyte derangements. Contrast-induced nephropathy can prolong hospitalization, result in greater morbidity and mortality, and increase patients' costs. A variety of preventive and treatment strategies exist, including use of alternative imaging. Critical care nurses need to understand the nephropathy and the patients at risk and to develop a familiarity with prevention, treatment, and outcome.
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Affiliation(s)
- Stephen P Wood
- Emergency Department, Winchester Hospital, Winchester, Massachusetts, USA.
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29
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Kaufman E, Lagu T, Hannon NS, Sagi J, Rothberg MB. Mythmaking in medical education and medical practice. Eur J Intern Med 2013; 24:222-6. [PMID: 23312964 DOI: 10.1016/j.ejim.2012.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/07/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the emergence of evidence-based medicine, gaps in medical knowledge are filled by tradition, common sense, and experience, giving rise to medical myths. METHODS We explored the origins of and evidence related to four medical myths: patients with shellfish allergies should not receive intravenous contrast, patients with atrial fibrillation of less than 48 hours' duration do not require anticoagulation before cardioversion, patients with suspected meningitis should have a computed tomography (CT) scan before a lumbar puncture, and patients with respiratory disease should not receive β-blockers. We conducted a literature review to describe each myth's origins and the quality of supporting evidence. RESULTS All patients with allergies, including but not limited to seafood allergies, are at an increased risk for anaphylactoid reactions to radiocontrast. No conclusive studies indicate that patients with atrial fibrillation of less than 48 hours' duration do not require anticoagulation before cardioversion. A CT scan before lumbar puncture in suspected acute bacterial meningitis is a clinically inefficient precaution. β-blockers can be safely used in patients with respiratory disease and may even prevent cardiac events in these patients. CONCLUSIONS These familiar myths have maintained prominent roles in medical thinking because they represent wisdom passed down from eminent sources, they teach physiology and medical skills, and they offer physicians a sense of control in the face of uncertainty. In addition to providing scientific evidence, changing physicians' practice requires acknowledging that even meticulous care cannot always avert bad outcomes.
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Affiliation(s)
- Elinore Kaufman
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Society for Vascular Nursing clinical practice guideline (CPG) for carotid artery stenting. JOURNAL OF VASCULAR NURSING 2013; 31:32-55. [PMID: 23481879 DOI: 10.1016/j.jvn.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 02/07/2023]
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31
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Schopp JG, Iyer RS, Wang CL, Petscavage JM, Paladin AM, Bush WH, Dighe MK. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol 2013; 20:299-306. [PMID: 23430296 DOI: 10.1007/s10140-012-1081-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 10/02/2012] [Indexed: 01/03/2023]
Abstract
The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed "breakthrough reaction." Identifying patient at high risk for an "allergy-type" reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.
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Affiliation(s)
- Jennifer G Schopp
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific St., Seattle, WA 98195, USA.
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Farnam K, Chang C, Teuber S, Gershwin ME. Nonallergic drug hypersensitivity reactions. Int Arch Allergy Immunol 2012; 159:327-45. [PMID: 22832422 DOI: 10.1159/000339690] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/23/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. METHODS We performed a PubMed search using the terms 'drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions' and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. RESULTS Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current 'gold' standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a 'desensitization' protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. CONCLUSIONS Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.
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Affiliation(s)
- Kevin Farnam
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA 95616, USA
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Mishra RK, Heavner JE, Day M. Prevalence of Adverse Reactions to Radiopaque Contrast Reported by Patients Presenting for Interventional Pain Procedure. Pain Pract 2012; 13:182-90. [DOI: 10.1111/j.1533-2500.2012.00571.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Davenport MS, Cohan RH, Caoili EM, Ellis JH. Repeat Contrast Medium Reactions in Premedicated Patients: Frequency and Severity. Radiology 2009; 253:372-9. [DOI: 10.1148/radiol.2532090465] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: retrospective review of 456,930 doses. AJR Am J Roentgenol 2009; 193:1124-7. [PMID: 19770337 DOI: 10.2214/ajr.09.2520] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and characteristics of adverse effects of low-osmolar iodinated and gadolinium contrast agents in a single-center experience with a large number of cases. MATERIALS AND METHODS A retrospective review of all intravascular doses of low-osmolar iodinated and gadolinium contrast materials administered from 2002 through 2006 was conducted. Adverse effects were identified through the use of radiologist and nurse event recording. Adverse effects were examined for type and severity of reaction, treatment required, and outcome. RESULTS A total of 456,930 contrast doses (298,491 low-osmolar iodinated, 158,439 gadolinium) were administered over the study period. A total of 522 cases of adverse effects (0.11% of total) were identified (458 low-osmolar iodinated, 64 gadolinium). The most common adverse effects were hives (274, 52.5%) and nausea (92, 17.6%). Of all adverse effects, 79 of low-osmolar iodinated and 15 of gadolinium contrast material necessitated treatment. Most treatments were performed in the radiology department alone. Only 16 cases of adverse effects necessitated transfer for further observation or treatment. Epinephrine was used to manage an adverse effect in nine instances. Thirty-two of the adverse effects of low-osmolar iodinated contrast material (6.9%) occurred in patients with a history of allergy who received premedication. Only two of these premedication reactions necessitated transfer to the emergency department. The one death in the study period occurred after administration of low-osmolar iodinated contrast material. The patient had no symptoms during the contrast administration or imaging but died suddenly within 30 minutes of receiving the dose. CONCLUSION Both iodinated and gadolinium contrast agents are associated with a very low rate of adverse effects. Most adverse effects are mild and can be managed in the radiology department. Transfer for additional treatment or observation is rarely needed.
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[Immediate allergy to iodinated contrast agents and prevention of reactions]. Rev Med Interne 2009; 30:872-81. [PMID: 19375199 DOI: 10.1016/j.revmed.2009.02.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/17/2009] [Accepted: 02/04/2009] [Indexed: 11/21/2022]
Abstract
The incidence and morbimortality of immediate hypersensitivity reactions following iodinated contrast media (ICM) injection remain unknown. The diagnosis of an immediate hypersensitivity reaction relies on a triad associating the precise description of the initial clinical manifestations and their delay of onset, the results of the biological assessment performed after the reaction including histamine and tryptase serum level measurements, and the results of skin testing with the culprit agent. Analysis of these data allows identification of the pathophysiologic mechanism of the reaction and the allergen involved in case of allergic hypersensitivity. Skin tests should be performed according to strict criteria. Cross-reactivity with ICM has to be investigated in order to propose a nonreactive ICM for future procedures. Allergic hypersensitivity to a given ICM imposes its definitive avoidance but not the avoidance of all iodinated drugs. The allergenic sequence has not yet been identified but is not the iodine atom itself. Asthma and treatment with beta-blockers are not risk factors of immediate allergic reactions to ICM per se, but may increase their severity. The various published protocols of premedication do not prevent the occurrence of an allergic/anaphylactic reaction to an ICM. The avoidance of the culprit ICM is the only way to prevent further reactions.
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Boehm I. Seafood allergy and radiocontrast media: are physicians propagating a myth? Am J Med 2008; 121:e19. [PMID: 18691465 DOI: 10.1016/j.amjmed.2008.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 03/10/2008] [Accepted: 03/11/2008] [Indexed: 12/24/2022]
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Sterling J. Recent Publications on Medications and Pharmacy. Hosp Pharm 2008. [DOI: 10.1310/hpj4305-429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics. Suggestions or comments may be addressed to: Jacyntha Sterling, Drug Information Specialist at Saint Francis Hospital, 6161 S Yale Ave., Tulsa, OK 74136 or e-mail: jasterling@saintfrancis.com .
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