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Ghiordanescu IM, Molinari N, Ciocănea-Teodorescu I, Schrijvers R, Motei C, Forsea AM, Demoly P, Chiriac AM. Skin Test Reactivity Patterns in Patients Allergic to Iodinated Contrast Media: A Refined View. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:705-713.e6. [PMID: 39056227 DOI: 10.1016/j.jaip.2023.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/30/2023] [Accepted: 10/23/2023] [Indexed: 07/28/2024]
Abstract
BACKGROUND Two-dimensional (2D) classifications of iodinated contrast media (ICM) are insufficient to explain the observed skin test (ST) reactivity patterns in patients with drug hypersensitivity reactions (DHRs) to ICM. OBJECTIVE To refine the current view on allergic DHRs to ICM by analyzing ST reactivity patterns in patients with previous reactions to ICM. METHODS Patients with a history of DHR to ICM and positive STs, who presented at the University Hospital of Montpellier between 2004 and 2022, were included in the study. The relative difference between every two ICM products was measured by Manhattan distance and odds ratios were computed for all pairs of products in the immediate reaction (IR) and non-immediate reaction (NIR) ST groups. RESULTS A total of 181 patients were included in the study. Odds ratio analysis identified significant associations between classical cross-reactive ICM, such as iohexol-ioversol, iohexol-iomeprol, iomeprol-ioversol, and iohexol-iodixanol in the IR ST group and iohexol-ioversol, iopromide-iohexol, and iomeprol-ioversol in the NIR ST group. We also identified uncommon associations, such as ioxitalamate-amidotrizoate in the IR ST group and amidotrizoate-iopamidol and amidotrizoate-ioxitalamate in the NIR ST group. The results were reflected by the Manhattan distance, which suggested the existence of clusters containing the same classically associated ICM as well as uncommon associations, which we hypothesize to be related to similarities in the 3D structure of the respective ICM. CONCLUSIONS Current chemical (2D) classifications cannot explain all observed ST reactivity patterns. Whether the 3D structure can be integrated into the current classifications to interpret the observed ST reactivity patterns and predict tolerance to alternative ICM requires further research.
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Affiliation(s)
- Ileana-Maria Ghiordanescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Dermatology and Allergy Clinic, Elias University Emergency Hospital, Bucharest, Romania.
| | - Nicolas Molinari
- Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Division of Medical Information, La Colombiere University Hospital of Montpellier, Montpellier, France
| | - Iuliana Ciocănea-Teodorescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Victor Babeș National Institute of Pathology, Bucharest, Romania
| | - Rik Schrijvers
- Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Cezara Motei
- Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Ana-Maria Forsea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dermatology and Allergy Clinic, Elias University Emergency Hospital, Bucharest, Romania
| | - Pascal Demoly
- Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Anca Mirela Chiriac
- Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
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Baek J, Jeong HW, Heo YJ, Yun S, Kang M, Kim B, Kim EJ, Lim SM, Lee B. Comparison of Safety and Diagnostic Efficacy of Iohexol 240 mgI/mL, Iopamidol 250 mgI/mL, and Iodixanol 270 mgI/mL in Cerebral Angiography: A Prospective, Multicenter Study. Neurointervention 2023; 19:82-91. [PMID: 38834304 DOI: 10.5469/neuroint.2024.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
PURPOSE This multicenter prospective study aimed to evaluate the quality and diagnostic effectiveness of cerebral angiography images obtained using low-concentration iodinated contrast agents (iohexol 240 mgI/mL, iopamidol 250 mgI/mL, and iodixanol 270 mgI/mL) and to assess the safety thereof. The study addresses the need for safer contrast agent alternatives without compromising the diagnostic quality of identifying cerebrovascular disease. MATERIALS AND METHODS Conducted in 5 medical centers in South Korea, we enrolled patients aged 19 years or older who were referred for diagnostic cerebral angiography under non-emergency conditions, excluding those with specific health conditions and sensitivities. The study design included a prospective, observational approach with a 1-way analysis of variance (ANOVA) for sample size calculation, aiming for a total sample of 231 participants for adequate power. Image quality was evaluated using a 4-level scale by 2 independent, blinded radiologists, and adverse reactions were monitored both immediately and up to 7 days post-procedure. Statistical analysis involved 1-way ANOVA and Kruskal-Wallis tests to assess the image quality and safety profiles of the contrast agents. RESULTS Among 266 patients screened, 243 were included in the final analysis. The evaluation revealed no statistically significant differences in image quality among the 3 types of low-concentration contrast agents. Adverse events were observed in 28.8% of patients, with 27.2% experiencing acute reactions, primarily mild reactions, and 3.3% experiencing delayed reactions. The overall safety profile showed no significant changes in vital signs or electrocardiogram readings before and after contrast agent injection. CONCLUSION Using low-concentration iodinated contrast agents for cerebral angiography provides image quality comparable to that of conventional high-concentration agents, with no significant increase in adverse events, suggesting a safer alternative for patients.
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Affiliation(s)
- Jinwook Baek
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Young Jin Heo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Suyoung Yun
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Myongjin Kang
- Department of Radiology, Dong-A University Hospital, Busan, Korea
| | - Byungjun Kim
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Boeun Lee
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
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3
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Zou W, Yang S, Chen L, Hu S, Hao G, Hu C. Iodixanol activation of mast cells: Implications in the pathogenesis of iodixanol-induced delayed cutaneous adverse reactions. Toxicology 2022; 465:153034. [PMID: 34774977 DOI: 10.1016/j.tox.2021.153034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/20/2022]
Abstract
Iodinated contrast media (ICM) is widely used in radiological examination and interventional therapy. In the commonly used ICM, iodixanol is considered to be the safer one. However, compared with other ICMs, it has a higher incidence of delayed cutaneous adverse reactions. The underlying mechanisms are unclear. In this study, mice with positive allergic reactions were selected based on the mouse clinical allergy symptom score and skin and blood samples taken 1, 6, 24, 48, and 72 h after ICMs (6 g iodine/kg) injection for histological and blood analyses. ICMs-induced pseudo-allergic reactions were investigated through in vivo intravital vascular imaging and passive cutaneous anaphylaxis (PCA) not mediated by IgE and through, calcium imaging degranulation of mast cells (MCs), and western blot assays in vitro. Results shows iodixanol-induced systemic anaphylaxis caused severe extravasation of plasma proteins and degranulation of skin MCs, and increased levels of plasma histamine, cytokines and inflammatory chemokines. Mechanistically, iodixanol increases degranulation of MCs and promotes the synthesis of inflammatory factors by activating PLC-γ and PI3K-related pathways. Trigonelline inhibit iodixanol-induced MC-related pseudo-allergic reactions in vitro and in vivo. These results suggest that mice in the iodixanol group had a higher incidence of delayed cutaneous reactions, characterized by cytokine release over time and delayed cutaneous MC degranulation. Iodixanol's delayed cutaneous adverse reactions may be due to a delayed phase of MC-related pseudo-allergic reactions. Trigonelline revealed anti-allergic activity in iodixanol-induced MC-related pseudo-allergic reactions.
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Affiliation(s)
- Weijie Zou
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Shuang Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Li Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Guangyu Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China.
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Brockow K. Diagnosing and Managing Patients with Reactions to Radiocontrast Media. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of the review
Iodinated radio contrast media (RCM) belong to the most common elicitors of drug hypersensitivity reactions (HR). Urticaria or anaphylaxis may occur ≤ 1(−6) hour(s) (immediate HR) and exanthems (non-immediate HR) develop > 6 h after application of RCM. Evidence for an immunologic mechanism of RCM HR against the different RCM benzene ring molecules and the benefit of allergological testing in patients with previous hypersensitivity reactions is progressively increasing.
Recent findings
Positive skin tests can confirm allergy in patients with previous reactions to RCM and help to select alternative better tolerated RCMs. Severe hypersensitivity reactions are mainly caused by an allergic mechanism, whereas the majority of non-severe reactions appear to be non-allergic. Skin testing is highly recommended to help identify allergic hypersensitivity reactions and to select alternatives. Using structurally different RCM is more effective than premedication for the prevention of future reactions. Drug provocation tests to RCM have been increasingly used, but are not yet standardized among different centers.
Summary
In patients with previous severe hypersensitivity reactions to RCM, skin testing is recommended. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test-negative preparations should be applied. Drug provocation tests do confirm or exclude RCM hypersensitivity or may demonstrate tolerability of alternative RCMs.
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK). DER KARDIOLOGE 2021. [PMCID: PMC8319902 DOI: 10.1007/s12181-021-00493-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dieses Manual zur diagnostischen Herzkatheteruntersuchung (Teil 1) ist eine Anwendungsempfehlung für interventionell tätige Ärzte, die den gegenwärtigen Kenntnisstand unter Berücksichtigung neuester Studienergebnisse wiedergibt. Hierzu wurde in den einzelnen Kapiteln speziell auf die Alltagstauglichkeit der Empfehlungen geachtet, sodass dieses Manual jedem interventionell tätigen Kardiologen als Entscheidungshilfe im Herzkatheterlabor dienen soll. Trotz der von vielen Experten eingebrachten praktischen Hinweise kann dieses Manual dennoch nicht die ärztliche Evaluation des individuellen Patienten ersetzen und damit eine Anpassung der Diagnostik bzw. Therapie ersetzen.
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Affiliation(s)
- Holger M. Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Stephan Achenbach
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | | | - Alexander Bufe
- Medizinische Klinik I, Helios Klinikum Krefeld, Krefeld, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - Oliver Dörr
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Albrecht Elsässer
- Herz- Kreislauf-Zentrum, Universitätsklinik für Innere Medizin – Kardiologie, Klinikum Oldenburg, Oldenburg, Deutschland
| | - Luise Gaede
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | - Tommaso Gori
- Zentrum für Kardiologie – Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
| | - Hans M. Hoffmeister
- Klinik für Kardiologie und allgemeine Innere Medizin, Städtisches Klinikum Solingen gemeinnützige GmbH, Solingen, Deutschland
| | - Felix J. Hofmann
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Hugo A. Katus
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Pneumologie), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christoph Liebetrau
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
- Abteilung für Kardiologie, Campus der JLU, Kerkhoff Bad Nauheim, Bad Nauheim, Deutschland
- CCB – Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Deutschland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, München, Deutschland
| | - Matthias Pauschinger
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | - Thomas Schmitz
- Klinik für Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum, Essen, Deutschland
| | - Tim Süselbeck
- Kardiologische Praxisklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Wolfram Voelker
- Medizinische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jens Wiebe
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gemeinnützige GmbH, Ludwigshafen, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Christian Hamm
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Angiologie und Nephrologie, Universitätsklinik Frankfurt, Frankfurt, Deutschland
| | - Helge Möllmann
- Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Deutschland
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Abstract
Injection of contrast media is the foundation of invasive and interventional cardiovascular practice. Iodine-based contrast was first used in the 1920s for urologic procedures and examinations. The initially used agents had high ionic and osmolar concentrations, which led to significant side effects, namely nausea, vomiting, and hypotension. Newer contrast agents had lower ionic concentrations and lower osmolarity. Modifications to the ionic structure and iodine content led to the development of ionic low-osmolar, nonionic low-osmolar, and nonionic iso-osmolar contrast media. Contemporary contrast agents are better tolerated and produce fewer major side effects.
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Heo YJ, Jeong HW, Kim D, Baek JW, Lee TH, Hwangbo L, Shin SH. Safety and tolerability of iobitridol in cerebral angiography: a prospective, multicenter study. Acta Radiol 2020; 61:331-337. [PMID: 31319690 DOI: 10.1177/0284185119861902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To date, only a few data have demonstrated the safety of iodinated contrast media for cerebral angiography. Purpose To assess contrast-related adverse events after cerebral angiography using iobitridol. Material and Methods A total of 790 patients who underwent cerebral angiography at three tertiary hospitals in the Republic of Korea between November 2017 and October 2018 were prospectively enrolled in this study. We interviewed all patients and recorded their symptoms before they left the interventional clinic after the angiography procedure and during the seven-day follow-up visit. The primary endpoints were acute (within 1 h) and delayed (1 h–7 days) adverse events associated with iobitridol injection. We also visually graded the radiographic density and image quality as secondary endpoints. Results Acute adverse events were more common than delayed adverse events. Most adverse events were either mild (96.5%) or moderate (3.45%). Among the contrast-related adverse events, feeling of warmth (59.1%) and altered taste (17.5%) were the most common acute events, whereas headache (41.9%) and allergic skin reactions (20.0%) were the most common delayed events. All cerebral angiography showed optimal density and good/excellent image quality. Conclusion The findings of this study suggest that iobitridol is a safe and effective iodinated contrast medium for use in cerebral angiography.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hae Woong Jeong
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jin Wook Baek
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Tae Hong Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - Lee Hwangbo
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - Shang Hun Shin
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Schönmann C, Brockow K. Adverse reactions during procedures: Hypersensitivity to contrast agents and dyes. Ann Allergy Asthma Immunol 2019; 124:156-164. [PMID: 31765812 DOI: 10.1016/j.anai.2019.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This review provides an overview of the literature on hypersensitivity reactions during procedures to commonly used contrast agents and dyes. A synthesis of current knowledge on clinical symptoms, epidemiology and risk factors, pathomechanism, and management of hypersensitivity reactions to these substances is presented. DATA SOURCES A literature search was conducted through Medline. Included were peer-reviewed articles written in English between 2000 and 2019. STUDY SELECTIONS Relevant clinical studies, experimental studies, and review articles have been selected. Additionally, case reports have been included if they carried significant information about rare clinical forms of hypersensitivity reactions, disease mechanisms, or therapy. RESULTS An allergological workup is only indicated for patients with a history of immediate (IHR) and nonimmediate hypersensitivity reactions (NIHR) but not for toxic or unrelated adverse events. Skin tests with or without experimental cellular laboratory tests in patients with previous reactions can provide evidence for an allergic mechanism. Positive skin tests indicating allergy are more common in severe reactions. If the adverse event was allergic, skin testing of alternatives is helpful for the selection of other contrast agents for future procedures. Premedication alone may be insufficient in these cases, and breakthrough reactions occur. For nonallergic reactions, change of contrast agent and premedication is often but not always sufficient to suppress reactions. CONCLUSION Patients with previous NIHR or IHR, especially moderate and severe IHR, needing potential re-administration of contrast agents should be skin tested to identify an allergic mechanism as well as alternative agents to be used for future procedures.
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Affiliation(s)
- Christine Schönmann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
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Sohn KH, Kim GW, Lee SY, Kim HS, Cho SH, Han JK, Kang HR. Immediate and delayed hypersensitivity after intra-arterial injection of iodinated contrast media: a prospective study in patients with coronary angiography. Eur Radiol 2019; 29:5314-5321. [PMID: 30937592 DOI: 10.1007/s00330-019-06138-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/18/2019] [Accepted: 03/07/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES While hypersensitivity reactions (HSR) to intravenously administered iodinated contrast media (ICM) have been well studied, not much is known about HSR to intra-arterially administered ICM. METHODS A prospective observational study was performed to evaluate coronary angiography (CAG)-induced ICM hypersensitivity in patients who underwent CAG using ICM including ioversol, a low-osmolar non-ionic monomer, and iodixanol, an iso-osmolar non-ionic dimer. The HSR were investigated through in-patient monitoring after CAG and telephone interview after discharge. RESULTS A total of 714 patients were enrolled during the observation period, of whom 26 (3.6%) showed immediate HSR and 108 (15.1%) showed delayed HSR. With regard to severity, proportion of immediate HSR grades 1, 2, and 3 was 57.7%, 38.5%, and 3.8%, respectively, whereas that of delayed HSR grades 1, 2, and 3 was 85.2%, 13.9%, and 0.9%, respectively. Multivariate analysis revealed that previous intra-arterial exposure to ICM was an independent risk factor for immediate HSR (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.22-6.96; p = 0.015). Iodixanol was a significant risk factor for delayed HSR (OR 1.61, 95% CI 1.07-2.43; p = 0.024) and correlated with a higher incidence of delayed HSR within 24-h post-ICM administration compared to ioversol. CONCLUSION The incidence rate of immediate and delayed HSR in intra-arterially administered ICM was 3.6% and 15.1%, respectively. Previous exposure to intra-arterially administered contrast media was a significant risk factor for immediate HSR. Compared to ioversol, iodixanol was associated with relatively earlier and more frequent delayed HSR. KEY POINTS • In this prospective study, the incidence of immediate and delayed hypersensitivity in intra-arterial injection of contrast media during coronary angiography was 3.6% and 15.1%, respectively. • Delayed hypersensitivity reactions were more common but less severe than immediate hypersensitivity reactions during coronary angiography. • Previous exposure to ICM via intra-arterial route was a significant risk factor for immediate hypersensitivity to intra-arterial contrast medium.
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Affiliation(s)
- Kyoung-Hee Sohn
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Gun-Woo Kim
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Internal Medicine, St. Carollo General Hospital, Suncheon, South Korea
| | - Suh-Young Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.,Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea
| | - Sang-Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.,Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, South Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea. .,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea. .,Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, South Korea.
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10
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Hwang JY, Choo KS, Choi YY, Kim JH, Ryu H, Han J, Kim YW, Jeon UB, Nam KJ. Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration. Pediatr Radiol 2017; 47:701-709. [PMID: 28236133 DOI: 10.1007/s00247-017-3795-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/22/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. OBJECTIVE To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. MATERIALS AND METHODS The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. RESULTS Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. CONCLUSION The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups.
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Affiliation(s)
- Jae-Yeon Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.
| | - Yoon Young Choi
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Junhee Han
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Yong-Woo Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Ung Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Kyung Jin Nam
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
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11
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Dewachter P, Mouton-Faivre C. Allergie aux médicaments et aliments iodés : la séquence allergénique n’est pas l’iode. Presse Med 2015; 44:1136-45. [DOI: 10.1016/j.lpm.2014.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/29/2014] [Accepted: 12/10/2014] [Indexed: 01/24/2023] Open
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12
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Safety and tolerability of iopromide in patients undergoing cardiac catheterization: real-world multicenter experience with 17,513 patients from the TRUST trial. Int J Cardiovasc Imaging 2015; 31:1281-91. [DOI: 10.1007/s10554-015-0688-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 06/01/2015] [Indexed: 01/06/2023]
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Meurer K, Laniado M, Hosten N, Kelsch B, Hogstrom B. Intra-arterial and intravenous applications of Iosimenol 340 injection, a new non-ionic, dimeric, iso-osmolar radiographic contrast medium: phase 2 experience. Acta Radiol 2015; 56:702-8. [PMID: 24938661 PMCID: PMC4427611 DOI: 10.1177/0284185114536157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Iosimenol 340 injection is a new, dimeric, iso-osmolar, iodinated contrast medium for X-ray angiography. PURPOSE To compare the safety and efficacy of iosimenol injection to iodixanol injection in two randomized, controlled phase 2 trials. MATERIAL AND METHODS One hundred and forty-four adult patients were enrolled in the two trials, one for evaluation during arteriography and the other for evaluation during computed tomography. Safety was compared by assessing adverse events, vital signs, ECGs, and laboratory parameters. Efficacy was assessed as X-ray attenuation in the computed tomography (CT) trial and as the quality of contrast enhancement in the arteriography trial. RESULTS There were no statistically significant differences in terms of safety or efficacy between the two contrast media. Both were well tolerated upon intravenous as well as intra-arterial injection. The most common adverse event was a feeling of warmth (observed in 35.1% of the patients with Iosimenol injection and 44.3% with iodixanol injection). CONCLUSION Iosimenol upon intravenous as well as upon intra-arterial injection exhibits a safety profile and shows an efficacy similar to that of iodixanol.
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Affiliation(s)
| | - Michael Laniado
- Institut und Poliklinik für Radiologische Diagnostik, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Norbert Hosten
- Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - Bettina Kelsch
- Department of Radiology, Charité, Humboldt University, Berlin, Germany
| | - Barry Hogstrom
- Otsuka Novel Products, Medical Imaging, Otsuka Pharmaceutical Development & Commercialization, Princeton, NJ, USA
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Brockow K, Sánchez-Borges M. Hypersensitivity to contrast media and dyes. Immunol Allergy Clin North Am 2015; 34:547-64, viii. [PMID: 25017677 DOI: 10.1016/j.iac.2014.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article updates current knowledge on hypersensitivity reactions to diagnostic contrast media and dyes. After application of a single iodinated radiocontrast medium (RCM), gadolinium-based contrast medium, fluorescein, or a blue dye, a hypersensitivity reaction is not a common finding; however, because of the high and still increasing frequency of those procedures, patients who have experienced severe reactions are nevertheless frequently encountered in allergy departments. Evidence on allergologic testing and management is best for iodinated RCM, limited for blue dyes, and insufficient for fluorescein. Skin tests can be helpful in the diagnosis of patients with hypersensitivity reactions to these compounds.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Biedersteiner Strasse 29, Munich 80802, Germany.
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Clínica El Avila, 6a transversal de Altamira, piso 8, consultorio 803, Caracas 1060, Venezuela
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Ly T, Stewart N, Lee S. Toxic epidermal necrolysis — an investigation to dye for? Med J Aust 2015; 202:51-2. [DOI: 10.5694/mja14.00367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 08/13/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Theresa Ly
- Concord Repatriation General Hospital, Sydney, NSW
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Radiation recall precipitated by iodinated nonionic contrast. Pract Radiat Oncol 2014; 5:263-6. [PMID: 25532490 DOI: 10.1016/j.prro.2014.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/04/2014] [Accepted: 11/07/2014] [Indexed: 11/23/2022]
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Delayed Adverse Reactions to the Parenteral Administration of Iodinated Contrast Media. AJR Am J Roentgenol 2014; 203:1163-70. [DOI: 10.2214/ajr.13.12310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Nonrenal complications of contrast media are caused by chemotoxic or anaphylactoid reactions related to the contrast agent used. Chemotoxicity is mainly attributed to ionic concentration and osmolality. Anaphylactoid reactions are typically caused by direct activation of basophils, mast cells, and complement rather than an observable antigen-antibody interaction, and may be acute or delayed. History of an adverse reaction following prior exposure is the strongest predictor of a subsequent adverse reaction to contrast. Premedication regimens of corticosteroids or antihistamines can lower the risk of repeat adverse reactions. Treatment of anaphylactoid reactions depends on the severity of symptoms.
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Affiliation(s)
- Damien Marycz
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone Street, 326 Wethington Building, Lexington, KY 40536-0200, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone Street, 326 Wethington Building, Lexington, KY 40536-0200, USA.
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Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. BIOMED RESEARCH INTERNATIONAL 2014; 2014:741018. [PMID: 24895606 PMCID: PMC4034507 DOI: 10.1155/2014/741018] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/03/2014] [Indexed: 12/18/2022]
Abstract
Radiocontrast media (RCM) are medical drugs used to improve the visibility of internal organs and structures in X-ray based imaging techniques. They may have side effects ranging from itching to a life-threatening emergency, known as contrast-induced nephropathy (CIN). We define CIN as acute renal failure occurring within 24-72 hrs of exposure to RCM that cannot be attributed to other causes. It usually occurs in patients with preexisting renal impairment and diabetes. The mechanisms underlying CIN include reduction in medullary blood flow leading to hypoxia and direct tubule cell damage and the formation of reactive oxygen species. Identification of patients at high risk for CIN is important. We have reviewed the risk factors and procedures for prevention, providing a long list of references enabling readers a deep evaluation of them both. The first rule to follow in patients at risk of CIN undergoing radiographic procedure is monitoring renal function by measuring serum creatinine and calculating the eGFR before and once daily for 5 days after the procedure. It is advised to discontinue potentially nephrotoxic medications, to choose radiocontrast media at lowest dosage, and to encourage oral or intravenous hydration. In high-risk patients N-acetylcysteine may also be given.
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Affiliation(s)
- Michele Andreucci
- Nephrology Unit, Department of “Health Sciences”, Campus “Salvatore Venuta”, “Magna Graecia” University, Loc. Germaneto, 88100 Catanzaro, Italy
| | - Richard Solomon
- University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT, USA
| | - Adis Tasanarong
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Khlong Luang, Pathum Thani 12121, Thailand
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Palena LM, Sacco ZD, Brigato C, Sultato E, Barra D, Candeo A, Manzi M. Discomfort assessment in peripheral angiography: Randomized clinical trial of Iodixanol 270 versus Ioversol 320 in diabetics with critical limb ischemia. Catheter Cardiovasc Interv 2014; 84:1019-25. [DOI: 10.1002/ccd.25412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/05/2013] [Accepted: 01/20/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Luis Mariano Palena
- Interventional Radiology Unit; Policlinico Abano Terme; Abano Terme (PD) Italy
| | - Zeno Dal Sacco
- Data Management Lead-MCRI International Clinical Operations; Brescia (BS) Italy
| | - Cesare Brigato
- Interventional Radiology Unit; Policlinico Abano Terme; Abano Terme (PD) Italy
| | - Enrico Sultato
- Interventional Radiology Unit; Policlinico Abano Terme; Abano Terme (PD) Italy
| | - Domenico Barra
- Interventional Radiology Unit; Policlinico Abano Terme; Abano Terme (PD) Italy
| | - Alessandro Candeo
- Interventional Radiology Unit; Policlinico Abano Terme; Abano Terme (PD) Italy
| | - Marco Manzi
- Interventional Radiology Unit; Policlinico Abano Terme; Abano Terme (PD) Italy
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Kim MH, Lee SY, Lee SE, Kim MY, Jo EJ, Park CM, Lee W, Cho SH, Kang HR. Clinical features of delayed contrast media hypersensitivity. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.5.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Heon Cho
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
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Azzouz M, Rømsing J, Thomsen HS. Late Adverse Events after Enhanced and Unenhanced MRI and CT: A Prospective Study. Basic Clin Pharmacol Toxicol 2013; 114:427-35. [DOI: 10.1111/bcpt.12175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Manal Azzouz
- Department of Diagnostic Radiology; Copenhagen University Hospital Herlev; Herlev Denmark
| | - Janne Rømsing
- Department of Drug Design and Pharmacology; University of Copenhagen; Copenhagen Ø Denmark
| | - Henrik S. Thomsen
- Department of Diagnostic Radiology; Copenhagen University Hospital Herlev; Herlev Denmark
- Department of Drug Design and Pharmacology; University of Copenhagen; Copenhagen Ø Denmark
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Kobayashi D, Takahashi O, Ueda T, Deshpande GA, Arioka H, Fukui T. Risk factors for adverse reactions from contrast agents for computed tomography. BMC Med Inform Decis Mak 2013; 13:18. [PMID: 23363607 PMCID: PMC3562527 DOI: 10.1186/1472-6947-13-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 01/21/2013] [Indexed: 12/22/2022] Open
Abstract
Background Symptoms of an adverse reaction to contrast agents for computed tomography are diverse ranging, and sometimes serious. The goal of this study is to create a scoring rule to predict adverse reactions to contrast agents used in computed tomography. Methods This was a retrospective cohort study of all adult patients undergoing contrast enhanced CT scan for 7 years. The subjects were randomly divided into either a derivation or validation group. Baseline data and clinically relevant factors were collected from the electronic chart. Primary outcome was any acute adverse reactions to contrast media, observed for during 24 hours after administration. All potential candidate predictors were included in a forward stepwise logistic regression model. Prediction scores were assigned based on β coefficient. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) and incidence of acute adverse reactions at each point were obtained. The same process was performed in the validation group. Results 36,472 patients underwent enhanced CT imaging: 20,000 patients in the derivation group and 16,472 in the validation group. A total of 409 (2.0%, 95% CI:1.9-2.3) and 347 (2.1%, 95% CI:1.9-2.3) acute adverse reactions were seen in the derivation and validation groups. Logistic regression analysis revealed that prior adverse reaction to contrast agents, urticaria, an allergic history to drugs other than contrast agents, contrast agent concentration >70%, age <50 years, and total contrast agent dose >65 g were significant predictors of an acute adverse reaction. AUC was 0.70 (95% CI:0.67-0.73) and 0.67 (95% CI:0.64-0.70) in the derivation and validation groups. Conclusions We suggest a prediction model consisting of six predictors for acute adverse reactions to contrast agents used in CT.
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Affiliation(s)
- Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan.
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Böhm I, Heverhagen JT, Klose KJ. Classification of acute and delayed contrast media-induced reactions: proposal of a three-step system. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:537-41. [DOI: 10.1002/cmmi.1475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic Radiology; Philipps University of Marburg; Marburg; Germany
| | | | - Klaus J. Klose
- Department of Diagnostic Radiology; Philipps University of Marburg; Marburg; Germany
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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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Pasternak JJ, Williamson EE. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist. Mayo Clin Proc 2012; 87:390-402. [PMID: 22469351 PMCID: PMC3538464 DOI: 10.1016/j.mayocp.2012.01.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 12/21/2011] [Accepted: 01/06/2012] [Indexed: 12/21/2022]
Abstract
Iodinated contrast agents have been in use since the 1950s to facilitate radiographic imaging modalities. Physicians in almost all specialties will either administer these agents or care for patients who have received these drugs. Different iodinated contrast agents vary greatly in their properties, uses, and toxic effects. Therefore, clinicians should be at least superficially familiar with the clinical pharmacology, administration, risks, and adverse effects associated with iodinated contrast agents. This primer offers the non-radiologist physician the opportunity to gain insight into the use of this class of drugs.
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Late adverse reactions to intravascular iodine based contrast media: an update. Eur Radiol 2011; 21:2305-10. [DOI: 10.1007/s00330-011-2200-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 05/18/2011] [Accepted: 05/27/2011] [Indexed: 12/11/2022]
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Patient discomfort associated with the use of intra-arterial iodinated contrast media: a meta-analysis of comparative randomized controlled trials. BMC Med Imaging 2011; 11:12. [PMID: 21609484 PMCID: PMC3125247 DOI: 10.1186/1471-2342-11-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 05/24/2011] [Indexed: 11/23/2022] Open
Abstract
Background Discomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with iso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM). Methods A review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed to compare rates of discomfort associated with the use of the IOCM (iodixanol) vs. various LOCM agents in head-to-head RCTs. All trials with a Jadad score ≥2 that reported patient discomfort data following intra-arterial administration of CM were reviewed, coded, and extracted. Results A total of 22 RCTs (n = 8087) were included. Overall discomfort (regardless of severity) was significantly different between patients receiving IOCM and various LOCMs (risk difference [RD] -0.049; 95% confidence interval [CI]: -0.076, -0.021; p = 0.001). IOCM was favored over all LOCMs combined with a summary RD value of -0.188 (95% CI: -0.265, -0.112; p < 0.001) for incidence of pain, regardless of severity. A greater reduction in the magnitude of pain was observed with IOCM (iodixanol), particularly with selective limb and carotid/intracerebral procedures. Similarly, the meta-analysis of warmth sensation, regardless of severity, favored IOCM over LOCMs with an RD of -0.043 (95% CI: -0.074, -0.011; p = 0.008). A positive linear relationship was observed between the discomfort effect size and age and a negative relationship with increasing proportion of women. The opposite trends were observed with warmth sensation. Conclusions IOCM was associated with less frequent and severe patient discomfort during intra-arterial administration. These data support differences in osmolality as a possible determinant of CM discomfort.
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Loh S, Bagheri S, Katzberg RW, Fung MA, Li CS. Delayed adverse reaction to contrast-enhanced CT: a prospective single-center study comparison to control group without enhancement. Radiology 2010; 255:764-71. [PMID: 20406882 DOI: 10.1148/radiol.10091848] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess the incidence of delayed adverse reactions (DARs) in patients undergoing contrast material-enhanced computed tomography (CT) with the low osmolar nonionic contrast agent iohexol and compare with the incidence of DARs in patients undergoing unenhanced CT as control subjects. MATERIALS AND METHODS Institutional review board approval and informed written consent for this prospective study were obtained. The study was HIPAA compliant. Patients undergoing CT for routine indications were enrolled from a random next-available scheduling template by an on-site clinical trials monitor. All subjects received a questionnaire asking them to indicate any DAR occurring later than 1 hour after their examination. Sixteen manifestations were listed and included rash, skin redness, skin swelling, nausea, vomiting, and dizziness, among others. To ensure maximal surveillance, a clinical trials coordinator initiated direct telephone contact for further assessment. Patients suspected of having moderately severe cutaneous reactions were invited to return for a complete dermatologic clinical assessment including skin biopsy, if indicated. Statistical analysis was performed by using a two-sided Wilcoxon-Mann-Whitney test, a logistic regression utilizing a chi(2) test to adjust for sex and age, and a two-sided Fisher exact test. RESULTS A total of 539 patients (258 receiving iohexol and 281 not receiving contrast material) were enrolled. DARs were observed in 37 (14.3%) of 258 subjects receiving iohexol and in seven (2.5%) of 281 subjects in the control group (P < .0001, chi(2) test) after adjusting for sex and age. Specific manifestations of DARs that were significantly more frequent at contrast-enhanced CT were skin rash (P = .0311), skin redness (P = .0055), skin swelling (P = .0117), and headache (P = .0246). DARs involving the skin included generalized rashes of the face, neck, chest, back, and extremities and were often associated with swelling, erythema, and pruritus. CONCLUSION This study substantiates a frequent occurrence of DARs at contrast-enhanced CT compared with that in control subjects. Continued growth in the use of contrast-enhanced CT suggests a need for greater awareness and attention to prevention and management.
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Affiliation(s)
- Shaun Loh
- Department of Diagnostic Radiology, University of California, Davis Medical Center, 4860 Y St, Suite 3100, Sacramento, CA 95817, USA.
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Brockow K. Immediate and Delayed Reactions to Radiocontrast Media: Is There an Allergic Mechanism? Immunol Allergy Clin North Am 2009; 29:453-68. [DOI: 10.1016/j.iac.2009.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chuang FR, Chen TC, Wang IK, Chuang CH, Chang HW, Ting-Yu Chiou T, Cheng YF, Lee WC, Chen WC, Yang KD, Lee CH. Comparison of iodixanol and iohexol in patients undergoing intravenous pyelography: a prospective controlled study. Ren Fail 2009; 31:181-8. [PMID: 19288321 DOI: 10.1080/08860220802669636] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Nephropathy associated with contrast medium exposure is a well-known complication of IVP. However, it is uncertain whether iso-osmolar non-iodinated contrast medium (iodixanol) is less nephrotoxic than low-osmolar contrast medium (iohexol). MATERIALS AND METHODS In this single-center, double-blind, prospective study, 50 patients undergoing IVP were randomized into two groups receiving different contrast medium: iodixanol and iohexol. Patients in high risk for contrast nephropathy were included, 28 with renal insufficiency and 19 with diabetes mellitus. We compared the nephrotoxic effect (contrast nephropathy), complement and cytokines profile between the iodixanol and iohexol groups. The mean volume of contrast medium in each IVP procedure was 0.8 mL/kg. RESULTS The incidence of contrast nephropathy was 4 percent among all patients (one iodixanol and one iohexol). We found no significant differences in contrast nephropathy and allergic reactions between the two groups. There was no significant difference in cytokine profiles in both groups (p > 0.05).The incidence of allergic reaction was 16 percent among all patients. Twelve percent (3/25) had late reaction after iohexol exposure compared to four percent (2/25) with iodixanol (p = 1.0). One patient had severe skin rash due to late adverse reaction after iodixanol. No mortality was found. CONCLUSIONS New iodixanol and iohexol contrast medium for routine IVP examination are safe and have low nephrotoxicity profile, especially in elderly or high-risk patients. Iodixanol contrast medium has an increased risk to induce severe late adverse reaction compared to iohexol. Allergic reaction may be the main adverse effect after contrast medium infusion.
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Affiliation(s)
- Feng-Rong Chuang
- Division of Nephrology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
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Wei K, Mulvagh SL, Carson L, Davidoff R, Gabriel R, Grimm RA, Wilson S, Fane L, Herzog CA, Zoghbi WA, Taylor R, Farrar M, Chaudhry FA, Porter TR, Irani W, Lang RM. The safety of deFinity and Optison for ultrasound image enhancement: a retrospective analysis of 78,383 administered contrast doses. J Am Soc Echocardiogr 2008; 21:1202-6. [PMID: 18848430 DOI: 10.1016/j.echo.2008.07.019] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND The purpose of this retrospective analysis was to define the incidence of severe adverse events after exposure to ultrasound contrast agents. METHODS Data between January 1, 2001, and September 30, 2007, were collected using invited responses to an on-line web-based questionnaire from 1 general and 12 cardiac ultrasound laboratories. During a period of 4.5 +/- 2.4 years, a total of 66,164 doses of Definity (Lantheus Medical Imaging, North Billerica, MA) and 12,219 doses of Optison (GE Healthcare, Buckinghamshire, UK) were administered, reflecting contrast use in 5% of transthoracic and 28% of stress echocardiographic procedures. More than 10,000 doses were given to critically ill patients in intensive care unit settings or to patients with acute chest pain of suspected cardiac origin. The median age of patients who received an ultrasound contrast agent was 60 years, 49% were male, and the mean body mass index was 32 +/- 1.4 g/m(-2). RESULTS Severe reactions that were considered "probably" related to an ultrasound contrast agent developed in 8 patients (0.01%), all of whom were outpatients, and 4 (0.006%) of these were consistent with anaphylactoid reactions. There were no deaths reported. All patients recovered with treatment. No serious events were seen in inpatients. CONCLUSION This multicenter, retrospective analysis includes the largest number of doses of ultrasound contrast agents ever published and a large number of patients evaluated in a wide variety of settings, including the critically ill. It shows that these agents have a good safety profile in both cardiac and abdominal ultrasound applications. The incidence of severe adverse reactions to ultrasound contrast agents is no greater, and may be lower, than that reported for contrast agents commonly used in other cardiac imaging tests.
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Affiliation(s)
- Kevin Wei
- Oregon Health and Science University, Portland, Oregon 97239, USA.
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Lapi F, Mugelli A, Vannacci A. “Allergic-like/allergic” or “hypersensitivity” reactions? An open debate on ADR terminology. Eur J Clin Pharmacol 2008. [DOI: 10.1007/s00228-008-0526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Safety aspects of iodinated contrast media related to their physicochemical properties: a pharmacoepidemiology study in two Tuscany hospitals. Eur J Clin Pharmacol 2008; 64:723-37. [PMID: 18401577 DOI: 10.1007/s00228-008-0477-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 02/20/2008] [Indexed: 01/18/2023]
Abstract
BACKGROUND More than 380,000 angiographic procedures are performed every year in Italian hospitals, with an increase rate of 8% per year. Although contrast media (CM) are considered relatively safe, adverse drug reactions (ADRs) remain an important issue. OBJECTIVES The objective of this study was to quantify the incidence of immediate and delayed nonrenal ADRs to iodinated CM in an Italian cohort and to evaluate whether their different physicochemical properties are able to affect the incidence of immediate or delayed ADRs. METHODS A prospective intensive monitoring study was conducted on a cohort of patients undergoing radiodiagnostic procedures with iodinated CM enrolled in two hospitals in Tuscany, Italy. To evaluate both immediate (within 1 h after CM administration) and delayed (>1 h to 1 week after CM administration) ADRs to CM, two questionnaires were administered. Adverse events (AEs) were analyzed to check the causality assessment between CM and ADR. If more than one symptom occurred in the same patient, they were treated as a single event. RESULTS One thousand five hundred and fourteen subjects who were exposed to iodinated CM completed the questionnaires. Mean age [standard deviation (SD)] was 65.4 (13.3) years, and 57.9% were male patients. A total of 178 [11.8%; 95% confidence interval (CI) 10.1-13.4] ADRs were reported. Thirty-four (2.2%; 1.5-3.1) and 144 (9.5%; 8.0-11.1) developed immediate and delayed ADRs, respectively. Both types of ADRs were experienced by six subjects (0.4%; 0.1-0.8). One hundred and seventy-six cases (98.8%; 96.0-99.8) were classified as possible and two (1.1%; 0.1-3.9) as probable ADRs. Monomeric low-osmolal (iopromide, iomeprol, iobitridol) and dimeric iso-osmolal (iodixanol) groups mainly reported delayed allergy-like ADRs of mild severity. Only one immediate reaction was severe. Multivariate analysis confirmed a higher risk of immediate reactions occurring for monomeric CM (OR 4.3; 95% CI 1.2-15.7), whereas the risk of delayed ADRs was significantly higher for the dimeric group (OR 1.8; 1.1-2.5). CONCLUSIONS Monomeric CM were more frequently involved in immediate ADRs, whereas dimeric CM were involved in delayed reactions. Although severe life-threatening ADRs to CM were confirmed to be rare, due to the large use of these drugs, they still retain clinical and epidemiological significance.
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Fernandez Cabezudo MJ, Petroianu G, Al-Ramadi B, Langer RD. Iosimenol, a new non-ionic dimeric contrast medium, does not induce immunoreactivity in the popliteal lymph node assay. Br J Radiol 2007; 80:713-8. [PMID: 17768167 DOI: 10.1259/bjr/38377769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Animal studies in mice were conducted to determine the potential immunoreactivity of the new non-ionic dimeric contrast medium (CM) iosimenol using the PLNA and flow cytometric analyses. Comparative studies were performed with iodixanol. The known immune-reactive substance strepozotocin (STZ) and vehicle injections served as positive and negative controls, respectively. Our experiments did not show any immunological effect of iosimenol, concluding that the new CM iosimenol may be beneficial for use in high-risk patients.
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Affiliation(s)
- M J Fernandez Cabezudo
- Department of Biochemistry, Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Tawam Street, Al Ain, Abu Dhabi, UAE
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Sandstede JJW, Roth A, Machann W, Kaupert C, Hahn D. Evaluation of the nephrotoxicity of iodixanol in patients with predisposing factors to contrast medium induced nephropathy referred for contrast enhanced computed tomography. Eur J Radiol 2007; 63:120-3. [PMID: 17317065 DOI: 10.1016/j.ejrad.2007.01.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 01/18/2007] [Accepted: 01/19/2007] [Indexed: 11/16/2022]
Abstract
To determine the risk of developing contrast induced nephropathy (CIN) in intermediate-risk patients receiving iodixanol, an iso-osmolar, dimeric non-ionic contrast agent, for CT in a clinical setting. Hundred consecutive patients referred for a contrast enhanced CT with a serum creatinine concentration>1.1mg/dl and/or a glomerular filtration rate (GFR)<90ml/min were included. Exclusion criteria were a serum creatinine>2.0mg/dl and a GFR<30ml/min or concurrent nephrotoxic agents. Between 60 and 140ml (mean 97+/-42ml) iodixanol (320mgI/ml) were administered at a flow of 2.5-3ml/s. Hydration with 500ml NaCl i.v. was performed before and after contrast injection. Follow-up was completed in 99 patients (age, 64+/-13 years, 68 men). CIN was defined as increase in serum creatinine concentration +0.5mg/dl or >25% above baseline within 72h after contrast administration. Serum creatinine concentration and GFR were 1.40+/-0.22, 1.29+/-0.29, and 1.26+/-0.29mg/dl and 52.2+/-13.9, 51.3+/-21.1, and 51.5+/-15.1ml/min on days 0, 3, and 7, respectively. Three out of 99 (3%) patients who received 90-110ml iodixanol revealed a CIN on day 3 without persistence on day 7. No specific therapy was needed. One out of 99 patients reported an exanthema on days 3 and 7. With the use of iodixanol in intermediate-risk patients, 3% of the patients develop CIN on day 3 without need for a specific therapy or persistence on day 7.
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Affiliation(s)
- Joern J W Sandstede
- Department of Radiology, University of Wuerzburg, Josef-Schneider-Strasse 2, D-97080 Wuerzburg, Germany.
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Jakobsen JA. Physiological effects of contrast media for use in multidetector row computed tomography. Eur J Radiol 2007. [DOI: 10.1016/j.ejrad.2007.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Immediate and non-immediate reaction after non-ionic X-ray contrast medium injection: Case report and review of the literature. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ejrex.2006.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vijayalakshmi K, Kunadian B, Wright RA, Hall JA, Stewart MJ, Davies A, Sutton A, de Belder MA. A prospective randomised controlled trial to determine the early and late reactions after the use of iopamidol 340 (Niopam™) and iomeprol 350 (Iomeron®) in cardiac catheterisation. Eur J Radiol 2007; 61:342-50. [PMID: 17101256 DOI: 10.1016/j.ejrad.2006.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 09/08/2006] [Accepted: 09/28/2006] [Indexed: 11/28/2022]
Abstract
UNLABELLED A new generation of intravascular contrast agents, the non-ionic monomers have safety profiles that are superior to those of older ionic compounds. There are, however, significant differences between these agents. AIM The aim of this study was to determine the incidence of early (<24h) and late (>24h to 7 days) reactions to two non-ionic contrast agents currently used during cardiac catheterisation: iopamidol 340 (Niopam Bracco UK Ltd.) and iomeprol 350 (Iomeron Bracco UK Ltd.). METHODS This was a prospective, randomised, double blinded trial. One thousand nine hundred and eighty-five patients undergoing cardiac catheterisation received one of the following contrast agents on a weekly basis: iopamidol 340 (Niopam) and iomeprol 350 (Iomeron). Reactions that were possibly related to the contrast agents were recorded on predefined data collection forms during the first 24h of the procedure (early reaction) and after 24h to 7 days (late reaction) by means of a questionnaire. RESULTS The baseline characteristics were matched in both the groups. There was no significant difference in the incidence of heat sensation experienced between the two groups (p=0.1). Early non-heat reactions occurred in 2.7% of patients receiving iopamidol 340 (Niopam) and 4% of those receiving iomeprol 350 (Iomeron) (p=0.1). Significant electrocardiographic changes were recorded in 1.7% of patients who received iopamidol 340 (Niopam), and 1% of those who received iomeprol 350 (Iomeron) (p=0.2). Bradycardia occurred more frequently in the iopamidol 350 group (0.8%) compared to the iomeprol 350 group (0.1%) p=0.02. Late reactions occurred in 16.2% of those receiving iopamidol 340 (Niopam) and 21.7% of those receiving iomeprol 350 (Iomeron) (p=0.02). A total of 23 (3.7%) patients in the iopamidol group and 39 (6.2%) patients in the iomeprol group reported nausea, p=0.01. CONCLUSIONS The incidence of early adverse reactions was similar with the two non-ionic contrast agents. Although bradycardia was slightly more frequent using iopamidol 340, nausea was reported more commonly 24h after the procedure in patients receiving Iomeron 350 (Iomeron). We conclude that there were only minor clinical differences between these agents; both are safe and well tolerated.
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Affiliation(s)
- Kunadian Vijayalakshmi
- Department of Cardiology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom.
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Böhm I, Medina J, Prieto P, Block W, Schild HH. Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence. Eur Radiol 2006; 17:485-9. [PMID: 16937101 DOI: 10.1007/s00330-006-0371-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 04/25/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
We describe the case of a 61-year-old physician who developed a fixed drug eruption (FDE) after i.v. administration of a non-ionic monomeric iodinated X-ray contrast medium (CM) (iopromide). During CM injection, a sensation of heat occurred, which was most intense in the right inguinal region. Four hours later, the FDE arose with a red macule of approximately 2 cm in diameter covering a dermal infiltration in the right inguinal region, and enlarged up to a final size of 15 x 8 cm, accompanied by a burning sensation. The patient's history revealed a similar reaction in the same localization and of the same clinical appearance after CM injection 1 year before. Patch testing 4 months later revealed positive reactions to iomeprol and iohexol. Iopamidol injection for another CT examination 23 months later was well tolerated. Based on these results, we suggest patch testing after CM-induced FDE, which could help to select a CM for future CT examinations. Late onset of adverse CM reactions may manifest as FDE. Patch testing within the previous skin reaction area is the diagnostic tool that should be used to confirm the suspected agent, possible cross-reacting agents and well-tolerated agents.
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Affiliation(s)
- Ingrid Böhm
- Department of Radiology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn, Germany.
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Peterson A, Katzberg RW, Fung MA, Wootton-Gorges SL, Dager W. Acute Generalized Exanthematous Pustulosis as a Delayed Dermatotoxic Reaction to IV-Administered Nonionic Contrast Media. AJR Am J Roentgenol 2006; 187:W198-201. [PMID: 16861512 DOI: 10.2214/ajr.05.0317] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to report three delayed, generalized, and protracted cutaneous reactions in two patients that are compatible with acute generalized exanthematous pustulosis (AGEP) after contrast medium administration. CONCLUSION Radiologists and referring clinicians need to be aware of late adverse reactions to the administration of contrast media and to distinguish these from other possible causes.
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Affiliation(s)
- Aaron Peterson
- Department of Radiology, University of California Davis Medical Center, 4860 Y St., Ste. 3100, Sacramento, CA 95817, USA
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Schild HH, Kuhl CK, Hübner-Steiner U, Böhm I, Speck U. Adverse Events after Unenhanced and Monomeric and Dimeric Contrast-enhanced CT: A Prospective Randomized Controlled Trial. Radiology 2006; 240:56-64. [PMID: 16720865 DOI: 10.1148/radiol.2393050560] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate adverse events (AEs) in patients who underwent nonionic monomeric or dimeric contrast media-enhanced computed tomography (CT) and to compare these effects with AEs in patients who underwent unenhanced CT. MATERIALS AND METHODS Local ethics committee approval and written informed consent were obtained. Patients were randomly assigned to the dimeric group, monomeric group, or concurrent control group. Acute (occurring during or within 1 hour after contrast agent injection) and delayed (occurring between 1 hour and 7 days after contrast agent injection) AEs were evaluated and categorized (mild, not requiring treatment; moderate, self-limiting AE requiring simple treatment; severe, AE requiring extensive treatment or endangering life). The two-sided Fisher exact test and the Mann-Whitney U and Wilcoxon signed rank tests were used for statistical analysis. RESULTS A total of 895 patients were recruited. Acute AEs were noted significantly (P < .05) more often in the monomeric group (44.8% [133 of 297 patients]) than in the dimeric (23.7% [71 of 300 patients]) or control (9.4% [28 of 298 patients]) groups. Two moderate acute AEs were noted in one patient in each contrast agent group; all other acute AEs were mild. There was no significant difference in the overall incidence of delayed AEs between the dimeric and monomeric groups (53.1% [139 of 262 patients] vs 50.8% [131 of 258 patients]). Delayed cutaneous AEs were noted significantly (P < .05) more often in the dimeric group. A total 16 AEs (2.0%) were moderate; no AE was severe. CONCLUSION The dimeric contrast agent caused fewer acute AEs than the monomeric contrast agent; however, the dimeric and monomeric agents caused a similar overall number of delayed AEs. Delayed cutaneous symptoms were noted more often with the dimeric contrast agent. Both contrast agents were safe in that no severe AEs and only a few moderate AEs were observed.
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Affiliation(s)
- Hans H Schild
- Department of Radiology, University of Bonn, Hospital and Medical School, Sigmund Freud Str 25, 53105 Bonn, Germany.
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Meth MJ, Maibach HI. Current understanding of contrast media reactions and implications for clinical management. Drug Saf 2006; 29:133-41. [PMID: 16454540 DOI: 10.2165/00002018-200629020-00003] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Iodinated contrast media (CM) are an integral part of modern diagnostic medicine. Although these agents are considered to be relatively safe, adverse effects in the form of allergy-like reactions occur in a significant number of exposed patients. These reactions may be divided into immediate and delayed responses. Immediate (within 1 hour of administration) anaphylactic reactions range from urticaria and angioedema to laryngeal oedema, hypotension and even death. Delayed reactions to CM occur from 1 hour to 1 week after administration and usually have mostly cutaneous manifestations. History of prior CM reactions and atopy predispose patients to CM reactions. Despite intense research into the pathogenesis of the immediate anaphylactoid responses, new evidence shows that true IgE type I hypersensitivity mediation occurs only in rare, severe cases. The aetiology appears to be multifactorial in most individuals. There is strong evidence to conclude that type IV hypersensitivity is responsible for the delayed reactions to CM. Although switching to non-ionic agents significantly reduces the incidence of immediate reactions to CM, there is little consensus regarding corticosteroid prophylaxis in high-risk individuals. Skin testing and provocative challenges also provide little security. Therefore, physicians must be better prepared to treat immediate anaphylactoid responses. Preventing delayed CM reactions is best performed with patch and delayed intradermal testing in those with a history of prior reactions, although false-negative results have been reported. Corticosteroids and antihistamines may be required for treatment. Until newer agents are developed that negate these issues, healthcare providers must strive to better understand the risk factors associated with CM reactions, as well as the available prophylactic and treatment options.
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Affiliation(s)
- Marc J Meth
- Department of Dermatology, UCSF School of Medicine, San Francisco, California, USA
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Böhm I, Schild HH. A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions. Eur Radiol 2006; 16:1570-9. [PMID: 16770655 DOI: 10.1007/s00330-006-0202-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 01/11/2006] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Abstract
The terms "immediate" and "delayed" adverse reactions induced by contrast media (CM) refer to the reactions' onset but do not provide substantial information concerning the clinical manifestation, the potential risk factors, the treatment modalities, or prevention. Because a variety of different reactions caused by different pathophysiological mechanisms may arise immediately or be delayed after CM injection, and because these need different management, the aim of the present paper is to present the clinical features and to exactly characterize lesser-known cutaneous reactions. A thorough knowledge of the clinical features, their adequate treatment, and, possibly, the subsequent diagnostic procedure for preventing recurrence after reexposure to CM would improve patient management.
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Affiliation(s)
- Ingrid Böhm
- Department of Radiology, University of Bonn, Sigmund-Freud Strasse 25, 53105, Bonn, Germany.
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Becker CR, Reiser MF. Use of iso-osmolar nonionic dimeric contrast media in multidetector row computed tomography angiography for patients with renal impairment. Invest Radiol 2005; 40:672-5. [PMID: 16189436 DOI: 10.1097/01.rli.0000178434.43939.a4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We wanted to determine the rate of contrast-induced nephropathy (CIN) caused in patients with renal impairment undergoing multidetector row computed tomography (MDCT) angiography with intravenous administration of iso-osmolar dimeric contrast media (iodixanol). MATERIALS AND METHODS The first consecutive 100 patients referred to CT with a serum creatinine level (SCr) between 1.5 and 6 mg/dL were enrolled in the study. Serum creatinine also was determined on days 3 and 7 after the intravenous administration of 100 mL of iodixanol 270 with 5 mL/s. A CIN was considered if variation of SCr on day 3 was >0.5 mg/dl above baseline. RESULTS Nine patients developed a CIN after MDCT angiography; 7 of them recovered completely by day 7, and the remaining 2 showed elevated SCr on day 7 but did not develop renal failure during their hospital stay. CONCLUSIONS MDCT angiography performed in patients with impaired renal function with iodixanol may result in CIN but complete recovery is probable.
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Affiliation(s)
- Christoph R Becker
- Department of Clinical Radiology, University Hospital Munich, Grosshadern, Munich, Germany.
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Briguori C, Colombo A, Airoldi F, Morici N, Sangiorgi GM, Violante A, Focaccio A, Montorfano M, Carlino M, Condorelli G, Ricciardelli B. Nephrotoxicity of low-osmolality versus iso-osmolality contrast agents: Impact of N-acetylcysteine. Kidney Int 2005; 68:2250-5. [PMID: 16221226 DOI: 10.1111/j.1523-1755.2005.00683.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent data support that iodixanol, an iso-osmolality contrast agent, is less nephrotoxic than low-osmolality contrast agents when hydration is the only prophylactic strategy used. We evaluated the nephrotoxicity of iso- and low-osmolality contrast agents with prophylactic administration of N-acetylcysteine (NAC) along with hydration. METHODS Two hundred and twenty-five patients with chronic renal insufficiency (serum creatinine >1.5 mg/dL or an estimated glomerular filtration rate <60 mL/min/1.73 m(2)), referred to our institution for coronary and/or peripheral procedures, were assigned to receive low-osmolality (iobitridol group; N = 115) or iso-osmolality (iodixanol group; N = 110) contrast dye. In all cases prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. RESULTS Baseline creatinine levels were similar in the 2 groups [iobitridol group = 1.70 (IQR: 1.54-1.98) mg/dL; iodixanol group = 1.73 (IQR: 1.56-2.00) mg/dL, P = 0.33]. The risk score for contrast nephrotoxicity was 5.0 +/- 1.6 in the iobitridol group versus 5.0 +/- 1.8 in the iodixanol group (P = 0.44). Increase of at least 0.5 mg/dL of the creatinine concentration 48 hours after the procedure occurred in 4/115 patients (3.5%) in the iobitridol group and 3/110 patients (2.7%) in the iodixanol group (P = 1.00; OR 0.78; 95% CI 0.17-3.56). Amount of contrast media administration was similar in the 2 groups (iobitridol group = 167 +/- 90 mL; iodixanol group = 164 +/- 82 mL; P = 0.61). CONCLUSION Nephrotoxicity of iso-osmolality and low-osmolality contrast agents was similar when a prophylactic strategy of hydration plus NAC was utilized.
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Affiliation(s)
- Carlo Briguori
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
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