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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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Gaspari F, Thakar S, Carrara F, Perna A, Trillini M, Aparicio M, Diadei O, Ferrari S, Cannata A, Stucchi N, Ruggenenti P, Remuzzi G, Perico N. Safety of Iohexol Administration to Measure Glomerular Filtration Rate in Different Patient Populations: A 25-Year Experience. Nephron Clin Pract 2018; 140:1-8. [DOI: 10.1159/000489898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
<b><i>Background/Aim:</i></b> In clinical research setting, accurate and precise measurement of glomerular filtration rate (GFR) is essential to overcome the limitations of GFR estimation with equations, which are often unreliable. In recent decades, a method for measuring GFR by plasma clearance of iohexol, a non-ionic radiocontrast agent, was developed. To evaluate the safety of the procedure, we aimed to review all immediate adverse reactions that could be related to iohexol administration in our group’s 25 years worth of experience. <b><i>Methods:</i></b> We retrospectively reviewed all GFR investigations in 2,891 patients, between 1992 and 2016, as part of 37 clinical trials coordinated by our group. Subjects with disparate renal diseases, kidney transplant recipients, and living donors – all with different renal function categories – were included in the surveyed clinical trials. <b><i>Results:</i></b> During 15,147 GFR measurements, only one treatment-related event of moderate intensity was identified. Flushing, urticaria, and itching were observed in a diabetic patient a few minutes after iohexol administration during the first GFR measurement. The event recovered without sequelae after intravenous injection of methylprednisolone sodium succinate. The patient was not hospitalized and the event was categorized as non-serious. Eight additional non-serious events observed closely following iohexol injection were considered as not related to treatment. Thus, independent of disease conditions and GFR categories, the overall rate of treatment-related events was 0.0066%. <b><i>Conclusion:</i></b> Iohexol administration for GFR measurement is a safe procedure, even in repeated investigations in the same subject, that should be adopted in clinical research and, when needed, also in clinical practice.
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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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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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NAGAI Y, TANAKA Y, NAKAZATO Y, SUGAWARA N, ARAI M, OKADA E, KOYAMA Y, HINOHARA H, YAMAMOTO K, KURABAYASHI M, NOJIMA Y, ISHIKAWA O. Autopsy case of delayed anaphylactic shock due to contrast medium. J Dermatol 2012; 39:852-4. [DOI: 10.1111/j.1346-8138.2012.01585.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Surveillance of contrast-media-induced hypersensitivity reactions using signals from an electronic medical recording system. Ann Allergy Asthma Immunol 2012; 108:167-71. [PMID: 22374199 DOI: 10.1016/j.anai.2012.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/11/2012] [Accepted: 01/16/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Contrast-media (CM) hypersensitivity is a well-known adverse drug reaction. Surveillance of adverse drug reactions usually depends on spontaneous reports. However, the rate of spontaneous reports is low. Recent progress in information technology enables the electronic search on signals of adverse drug reactions from electronic medical recording (EMR) systems. OBJECTIVES To analyze the incidence and clinical characteristics of CM hypersensitivity using an EMR-based surveillance system. METHODS The surveillance system used signals from standardized terms within the international classification of nursing practice terms that can indicate symptoms of CM hypersensitivity and from the order codes for procedures that used contrast media, antihistamine, and epinephrine. The search strategy was validated by allergists comparing the electronic search strategy versus manually reviewing medical charts over one month. The main study covered for one year period. RESULTS Detection rate of the electronic search method was 0.9% (7/759), while that of the manual search method was 0.8% (6/759). EMR-based electronic search method was highly efficient: reduced the charts that needed to be reviewed by 96% (28/759). The sensitivity of electronic screening was 66.7%, specificity was 99.6%, and the negative predictive value was 99.7%. CM hypersensitivity reactions were noted in 266 among 12,483 cases (2.1%). Urticaria was the most frequent symptom (74.4%). CT was the most frequent procedure (3.6%) that induced CM hypersensitivity. CONCLUSION A surveillance system using EMR may be a useful tool in the study of drug hypersensitivity epidemiology and may be used in an adverse drug reaction alarm system and as a clinical, decision making support system.
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Jung KE, Chung J, Park BC, Jee KN, Jee YK, Kim MH. A clinical study of cutaneous adverse reactions to nonionic contrast media in Korea. Ann Dermatol 2012; 24:22-5. [PMID: 22363151 PMCID: PMC3283846 DOI: 10.5021/ad.2012.24.1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 06/27/2011] [Accepted: 06/28/2011] [Indexed: 11/08/2022] Open
Abstract
Background The use of intravenous contrast media (CM) has increased for the diagnosis of several diseases. The newly developed low osmolar nonionic contrast agents cause significantly decreased adverse reactions than the higher osmolar ones. However, adverse reactions may still occur, ranging in severity from minor side effects to severe complications. However, there have been few reports about cutaneous adverse reactions (CARs) to nonionic monomer CM. Objective The purpose of this study was to evaluate clinical features of CAR to intravenous nonionic monomer CM. Methods A total 47,338 examinees underwent intravenous iodinated contrast-enhanced computed tomography scan using nonionic monomer CM. Among the adverse reactions to the CM, we divided them into cutaneous or noncutaneous and immediate (<1 hr) or late (≥1 hr) adverse reactions. Results Adverse reactions were noted in 62 cases out of the total 47,338 cases; 50 cases (80.7%) were categorized CARs. Among them, there were 24 male and 26 female patients. There was no significant difference between the sexes, and CARs occurred in all age groups. The highest occurrence was in the age range of 50~59 years. CARs included urticaria (78%), angioedema (10%), maculopapular rash (8%), erythema (2%), and pruritus without rash (2%). Immediate reactions were 92% (46 cases), while late reactions were 8% (4 cases). Conclusion CARs to nonionic monomer CM accounted for most of the adverse reactions (80.7%) and urticaria was the most common.
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Affiliation(s)
- Kyung Eun Jung
- Department of Dermatology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Khachman D, Gandia P, Sallerin F, Mailly N. [Immediate and delayed hypersensitivity reactions to iodinated radiographic contrast agents: an update]. Therapie 2009; 64:331-9. [PMID: 19863909 DOI: 10.2515/therapie/2009040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnostic and interventional radiology of patients is nowadays crucial with increasing requirement for iodinated contrast agents infusion. Besides adverse reactions after administration of the iodinated contrast agents due to their toxicity, immediate hypersensitivity reactions and reactions resembling delayed hypersensitivity appearing from 1 hour to several days later, have been reported. Patients at high risk to develop such adverse events have to be detected on the basis of their risk factors in order to prevent or limit serious outcomes. Previous reactions to contrast media, asthma, atopy and cardiovascular disorders are risk factors for anaphylactic or anaphylactoid reactions. Female gender, age and beta-blockers increase the severity. This article aims to summarize the risk of allergic reactions related to the use of iodinated contrast agents and to suggest a way for diagnosis, treatment and prevention according to each clinical situation.
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Affiliation(s)
- Dalia Khachman
- Laboratoire de Pharmacocinétique et Toxicologie Clinique, Hôpital Purpan, Institut Fédératif de Biologie, Toulouse, France
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Affiliation(s)
- Ilan Gottlieb
- Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA
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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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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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Juergens CP, Khaing AM, McIntyre GJ, Leung DYC, Lo STH, Fernandes C, Hopkins AP. Adverse Reactions of Low Osmolar Non-Ionic and Ionic Contrast Media When Used Together or Separately During Percutaneous Coronary Intervention. Heart Lung Circ 2005; 14:172-7. [PMID: 16352273 DOI: 10.1016/j.hlc.2005.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2004] [Revised: 05/19/2005] [Accepted: 06/15/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to perceived advantages in the use of non-ionic contrast agents for diagnostic angiography and ionic agents for percutaneous coronary intervention (PCI), patients often receive various combinations of both types of agents. AIM To assess potential adverse effects of non-ionic and ionic contrast media when used together or separately during percutaneous coronary intervention. METHODS We retrospectively evaluated the outcomes of 532 patients undergoing percutaneous coronary intervention in our institution. Patients were divided into two groups: those that underwent diagnostic angiography and "follow on" PCI; and those that underwent "planned" PCI. The groups were subdivided on the basis of the use of the ionic agent ioxaglate or the non-ionic agent iopromide during PCI. The frequency of allergic reactions and major adverse cardiac events (MACE) were noted. RESULTS With respect to the "follow on" group, allergic reactions occurred in 9 of 150 patients (6.0%) who received the combination of ioxaglate and iopromide versus 1 of 93 (1.1%) who only received iopromide (p=0.094). There was no difference with respect to MACE [6 (4.0%) ioxaglate and iopromide versus 4 (4.3%) iopromide alone, p=1.00]. In the "planned" group, 7 of 165 patients (4.2%) receiving ioxaglate had an allergic reaction as opposed 0.0% (0 of 124 patients) in the iopromide group (p=0.021). All contrast reactions were mild. The incidence of a MACE was similar in both groups [1 (0.6%) ioxaglate versus 2 (1.6%) iopromide, p=0.579]. The incidence of allergic reactions was similar if ioxaglate was used alone or in combination with iopromide (p=0.478). CONCLUSIONS Whilst combining ionic and non-ionic contrast agents in the same procedure was not associated with any more adverse reactions than using an ionic contrast agent alone, the ionic contrast agent ioxaglate was associated with the majority of allergic reactions. With respect to choice of contrast agent, using the non-ionic agent iopromide alone for coronary intervention is associated with the lowest risk of an adverse event.
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Affiliation(s)
- Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Locked Bag 7103, Elizabeth Street, Liverpool, NSW 2170 Australia.
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Böhm I, Speck U, Schild H. A possible role for cysteinyl-leukotrienes in non-ionic contrast media induced adverse reactions. Eur J Radiol 2005; 55:431-6. [PMID: 16129253 DOI: 10.1016/j.ejrad.2005.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 12/02/2004] [Accepted: 01/07/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE To test whether mono- or dimeric X-ray contrast media (CM) may induce the de novo production of cysteinyl-leukotriens (cys-LT), that could contribute to allergic/allergy-like side effects. MATERIALS AND METHODS Leukocytes from 39 patients receiving iopromide or iotrolan for routine CT-examination were analyzed for the production of cys-LT. Histamine levels were analyzed in plasma specimens. One patient with a positive history of a previous CM-reaction did not receive CM-injection. RESULTS Three patients of the iopromide and five of the iotrolan group showed adverse reactions. Reactors had increased cys-LT values in samples obtained before CM-injection induced by the positive control (anti-FcepsilonRI antibodies) (6763.7 pg/ml+/-1367.3 versus 2299.8 pg/ml+/-399.2; p<0.007). Patients with versus without CM-reaction did not differ significantly with respect to their histamine values before CM-administration. In vitro iopromide (p<0.0002) and iotrolan (p<0.0008) induced significant cys-LT production as compared to IL-3 stimulation. In vivo both CM induced a significant increase 6h after CM administration (p<0.05). CONCLUSION Our findings suggest that both CM seem to induce cys-LT production. As to whether the observed increased values in pre-dose samples of patients with as compared to those without reactions could contribute to identify high risk patients should be investigated in larger patient groups in future.
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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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Idée JM, Pinès E, Prigent P, Corot C. Allergy-like reactions to iodinated contrast agents. A critical analysis. Fundam Clin Pharmacol 2005; 19:263-81. [PMID: 15910651 DOI: 10.1111/j.1472-8206.2005.00326.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Allergy-like reactions may occur following administration of iodinated contrast media (CM), mostly in at-risk patients (patients with history of previous reaction, history of allergy, co-treated with interleukin-2 or beta-blockers, etc.) but remain generally unpredictable. Severe and fatal reactions are very rare events. All categories of CM may induce such reactions, although first generation (high osmolar CM) have been found to induce a higher rate of adverse events than low osmolar CM. However, no differences were found between the two categories of CM with respect to mortality. Delayed reactions can also occur. There are no differences between the various categories of CM except for non-ionic dimers, which are more likely to induce such effect. Numerous clinical studies have evaluated the prophylactic value of drugs (mostly antihistamines and corticosteroids). Results are unclear and highly variable. Any prevention depends upon the mechanism involved. However, the mechanism of CM-induced allergy-like reaction remains disputed. Relatively recent data revived the hypothesis of a type-I hypersensitivity mechanism. Positive skin tests to CM have been reported. However, the affinity of IgE towards CM has been found to be very low in the only study which actually evaluated it. Other pathophysiological mechanisms (involving direct secretory effects on mast cells or basophils, or activation of the complement system associated or not with the plasma contact system) are also much debated. Anaphylaxis and anaphylactoid reactions are, in the end, clinically undistinguishable.
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Affiliation(s)
- Jean-Marc Idée
- Guerbet, Research Division BP57400 Roissy-Charles de Gaulle Cedex, France.
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Abstract
X-ray contrast media are chemically inert drugs which are given intravascularly in very high amounts within a very short time period. Although they are regarded as relatively safe drugs, adverse reactions can occur: these are normally divided into immediate and delayed reactions. The latter appear hours to days after injection. Immediate reactions have been drastically reduced since the introduction of non-ionic monomers and non-ionic dimers. However, the delayed reactions still occur in a frequency of 1-3% in X-ray contrast media exposed patients. The majority of these reactions are mild and manifest as skin eruption, but severe reactions can also occur. Further improvement of the safety of these drugs is only possible with a better understanding of etiologies behind the observed adverse reactions.
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Affiliation(s)
- Cathrine Christiansen
- Research and Development, Amerham Health AS, GE Healthcare, Postbox 4220 Nydalen, N-0401 Oslo, Norway.
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Malinovsky JM, Mertes PM, Demoly P. [Iodine allergy: myth or reality?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:10-2. [PMID: 15661458 DOI: 10.1016/j.annfar.2004.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Sánchez-Pérez J, F-Villalta MG, Ruíz SA, García Diez A. Delayed hypersensitivity reaction to the non-ionic X-ray contrast medium Visipaque (iodixanol). Contact Dermatitis 2003; 48:167. [PMID: 12755737 DOI: 10.1034/j.1600-0536.2003.00051.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Javier Sánchez-Pérez
- Department of Dermatology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
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Romano A, Artesani MC, Andriolo M, Viola M, Pettinato R, Vecchioli-Scaldazza A. Effective prophylactic protocol in delayed hypersensitivity to contrast media: report of a case involving lymphocyte transformation studies with different compounds. Radiology 2002; 225:466-70. [PMID: 12409581 DOI: 10.1148/radiol.2251011654] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A patient with maculopapular reactions to iopamidol needed to undergo angiography for a cerebral arteriovenous malformation. In vivo and in vitro tests were performed with ionic and nonionic contrast media, including iopamidol and iobitridol. All results were positive, demonstrating delayed hypersensitivity. The patient received 6-alpha-methylprednisolone and cyclosporine 1 week before and 2 weeks after four angiograms were obtained with the use of iobitridol, which was well tolerated.
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Affiliation(s)
- Antonino Romano
- Department of Internal Medicine and Geriatrics, Universita' Cattolica del Sacro Cuore, Allergy Unit, Complesso Integrato Columbus, Via G. Moscati 31, 00168 Rome, Italy.
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Abstract
PURPOSE OF REVIEW The purpose of the present review is to describe recent insight into the pathomechanism of the late-onset allergy-like reactions which affect 2-3% of contrast medium-exposed patients, and to give advice regarding prophylactic measures to avoid recurrence of such reactions. RECENT FINDINGS It is well recognized that the majority of contrast media-induced late-onset reactions are cutaneous reactions of the maculopapular, urticarial and angioedema types, with occasional occurrence of more serious, bullous eruptions. Recent findings strongly indicate that these reactions are T cell-mediated. The current evidences for this concept are the described clinical symptoms; the high incidence of reactions in interleukin-2-treated patients; the positive results from skin, provocation and lymphocyte transformation testing of affected patients; and the histopathology of skin eruptions and positive skin test sites. SUMMARY On the basis of this new knowledge, several prophylactic measures are proposed to avoid repeat reactions in patients with previous late-onset contrast medium reactions. All persons receiving contrast media should be informed that transient skin reactions may develop up to 7 days after contrast medium exposure. Those who experience such reactions should be advised to see an allergist for diagnosis of the reaction. Skin testing with a panel of different contrast media appears to be useful for confirming the presence of an allergic reaction and for identifying alternative contrast media that can be safely used. For undiagnosed persons, a contrast medium that is structurally different from the product that precipitated the reaction should be chosen if re-exposure to contrast media is required. Pretreatment with corticosteroids may also be tried, although its protective effect has not been systematically studied.
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Affiliation(s)
- Cath Christiansen
- Research and Development, Amersham Health, PO Box 4220, Nydalen, 0401 Oslo, Norway.
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Affiliation(s)
- Sachiko T Cochran
- Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA 90095-1721, USA
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Moneret-Vautrin DA, Kanny G, Morisset M, Beaudouin E, Renaudin JM. [Anaphylactoid reactions and late skin reactions to iodinated contrast media: present state of the question--idea development]. Rev Med Interne 2001; 22:969-77. [PMID: 11695320 DOI: 10.1016/s0248-8663(01)00455-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Adverse reactions to iodinated contrast media (ICM) share various mechanisms. Anaphylactoid reactions are among the most serious reactions when they are characterized by the elevation of seric tryptase. Pretreatment with corticosteroids and anti-H1 or the use of non-ionic contrast media do not prevent anaphylaxis. Late skin reactions could be mostly related to delayed hypersensitivity. Previous reactions to contrast media, cardiovascular disorders, beta-blockers, asthma, and atopy are risk factors. Female gender and age increase the severity. CURRENT KNOWLEDGE AND KEY POINTS Anaphylaxis can be demonstrated by intradermal tests and the identification of specific IgEs. Delayed hypersensitivity is shown by the results of epicutaneous tests and the immunohistology of the skin. FUTURE PROSPECTS AND PROJECTS Allergologic tests are advised in the case of previous reactions. In case of emergency, gadopentetate dimeglumine can be alternatively used. The other risk factors lead to the combination of pretreatment and use of non-ionic monomeric contrast media. Immediate hypersensitivity to iodinated media might increase in the near future with the use of divalent molecules.
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Affiliation(s)
- D A Moneret-Vautrin
- Service de médecine interne, immunologie clinique et allergologie, hôpital Central, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
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Cochran ST, Bomyea K, Sayre JW. Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 2001; 176:1385-8. [PMID: 11373197 DOI: 10.2214/ajr.176.6.1761385] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Data collected from 1985 to 1999 on adverse events after the IV administration of contrast media were evaluated to identify trends. MATERIALS AND METHODS Data collected on 391 adverse events after 90,473 administrations of iodinated contrast media and 19 events after 28,340 administrations of gadolinium were evaluated. Reactions were graded as mild, moderate, or severe. Data were also collected regarding contrast extravasation. RESULTS When only ionic iodinated contrast material was used, the adverse reaction rate was 6-8%. With the selective use of contrast material, the adverse reaction rate was 0.6% and 0.7%, respectively, for ionic and nonionic agents. The rate decreased to 0.2% with the universal use of nonionic agents. More than 90% of adverse reactions were allergic-like. Seven severe reactions (0.05%) and no deaths occurred in the ionic group. During the selective use period, one death occurred in the nonionic group. No severe reactions or deaths occurred during the first 5 years of universal nonionic use. Since then, 10 severe reactions (0.02%) and one death have occurred. Seven reactions occurred in patients after helical CT angiography. The extravasation rate for iodinated contrast material has remained constant at 0.3-0.4% annually. The adverse reaction rate to gadolinium contrast material was 0.06%. CONCLUSION Mild and moderate adverse events are more common with ionic contrast material than with nonionic. Most reactions are allergic-like. Severe reactions are seen equally with ionic and nonionic contrast material but differ in type. The reactions were allergic-like in the ionic group but were predominantly attributable to cardiopulmonary decompensation in the nonionic group. Helical CT angiography may play a role in reactions.
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Affiliation(s)
- S T Cochran
- Department of Radiological Sciences, UCLA School of Medicine, 10833 Le Conte Ave., Los Angeles, CA 90095-1721, USA
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