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Rašiová M, Schlager O, Heiss C, Brodmann M, Olinic DM, Boc V, Buso G, Belch J, Mazzolai L, Madaric J. Adverse reactions after intravascular iodinated contrast media administration and their management. VASA 2024; 53:193-203. [PMID: 38651340 DOI: 10.1024/0301-1526/a001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Endovascular interventions and diagnostic examinations using iodinated contrast media (ICM) are standard of care in current vascular medicine. Although ICM use is generally considered safe, it may be associated with adverse reactions, vary from minor disturbances to rare, but severe life-threatening complications. This position paper of European Society of Vascular Medicine integrates current knowledge and summarizes the key information related to the use of intravascular ICM, serving as recommendation on prevention and management of acute, late, and very late adverse reactions. It should help the health professionals in all fields of vascular medicine to make decisions in daily practice for safe use of contrast media.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, Faculty of Medicine, University of Pavol Jozef Šafárik, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Vascular Department, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, United Kingdom
| | | | - Dan Mircea Olinic
- Department of Interventional Cardiology, Medical Clinic No. 1, Emergency County Hospital, Cluj-Napoca, Romania
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - Jill Belch
- Division of Molecular and Clinical Medicine, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madaric
- Department of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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Xu W, Chen M, Liu S, Su Y, Zhang Y. Transient pulmonary and gastric bleeding after iopamidol administration in a patient with marginal zone lymphoma: a case report. BMC Pulm Med 2024; 24:198. [PMID: 38649880 PMCID: PMC11036599 DOI: 10.1186/s12890-024-02993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Iopamidol is a non-ionic, water-soluble iodine contrast agent that is considered safe for intravenous or intra-arterial administration and is widely used both in the general population and in patients undergoing oncological treatment. While adverse reactions to iopamidol have been documented, to date, no pulmonary and gastric hemorrhages induced by iopamidol have been reported in oncology patients. We report the first case of this complication. CASE PRESENTATION We report the case of a 60-year-old woman with marginal zone lymphoma who was receiving antineoplastic therapy. As part of the investigation for the condition, she underwent chest enhancement CT with iopamidol. Shortly thereafter(within five minutes), she experienced hemoptysis and hematemesis. She was intubated and admitted to the intensive care unit. Pre- and post-contrast images demonstrated the course of the hemorrhage. Flexible bronchoscopy and gastroscopy on the following day showed no active bleeding, and the patient recovered completely after antiallergy treatment. We speculate that contrast-induced hypersensitivity was the most likely cause of the transient pulmonary and gastric bleeding. CONCLUSION Although rare, the complications of iopamidol, which may cause allergic reactions in the lungs and stomach, should be considered.
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Affiliation(s)
- Weixian Xu
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Miaozhen Chen
- Foshan Clinical Medical School of Guangzhou University of Chinese Medicine, 3 Sanyou South Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Songtao Liu
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Yi Su
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Yunhai Zhang
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China.
- Department of Critical Care Medicine, Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China.
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Butranova O, Zyryanov S, Gorbacheva A, Asetskaya I, Polivanov V. Drug-Induced Anaphylaxis: National Database Analysis. Pharmaceuticals (Basel) 2024; 17:90. [PMID: 38256923 PMCID: PMC10821106 DOI: 10.3390/ph17010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: National health system databases represent an important source of information about the epidemiology of adverse drug reactions including drug-induced allergy and anaphylaxis. Analysis of such databases may enhance the knowledge of healthcare professionals regarding the problem of drug-induced anaphylaxis. (2) Methods: A retrospective descriptive analysis was carried out of spontaneous reports (SRs) with data on drug-induced anaphylaxis (SRsAs) extracted from the Russian National Pharmacovigilance database (analyzed period 2 April 2019-21 June 2023). The percentage of SRsAs among SRs of drug-induced allergy (SRsDIAs) was calculated, as well as of pediatric, elderly, and fatal SrsAs. Drugs involved in anaphylaxis were assessed among total SRsAs, pediatric, and elderly SRsAs, and among fatal SRsAs. Demographic parameters of patients were assessed. (3) Results: SRsAs were reported in 8.3% of SRsDIAs (2304/27,727), the mean age of patients was 48.2 ± 15.8 years, and females accounted for 53.2% of cases. The main causative groups of drugs were antibacterials (ABs) for systemic use (44.6%), local anesthetics (20.0%), and cyclooxygenase (COX) inhibitors (10.1%). Fatal SRsAs were reported in 9.5% (218/2304) of cases, the mean age of patients was 48.0 ± 16.7 years, and females accounted for 56.4% of cases. Pediatric SRsAs accounted for 3.9% of pediatric SRsDIAs and 5.8% of all SRsAs, with a mean age of 11.8 ± 4.5 years, and females acccounted for 51.9% of cases. Elderly SRsAs accounted for 2% of elderly SRsDIAs and 2.8% of all SRsAs, and the mean age was 73.0 ± 5.3 years, and females accounted for 43.5% of cases. ABs caused 40% of SRsAs in the elderly, 42.9% in children, and 50% of fatal SRsAs. (4) Conclusions: Our study revealed a relatively high proportion of anaphylaxis among SRs of drug-induced allergy. ABs were the most prevalent causative agents, especially in fatal SRsAs.
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Affiliation(s)
- Olga Butranova
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
| | - Sergey Zyryanov
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
- Moscow City Health Department, City Clinical Hospital No. 24, State Budgetary Institution of Healthcare of the City of Moscow, Pistzovaya Srt. 10, 127015 Moscow, Russia
| | - Anastasia Gorbacheva
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
| | - Irina Asetskaya
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
| | - Vitaly Polivanov
- Pharmacovigilance Center, Information and Methodological Center for Expert Evaluation, Record and Analysis of Circulation of Medical Products under the Federal Service for Surveillance in Healthcare, 4-1 Slavyanskaya Square, 109074 Moscow, Russia;
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Fukushima Y, Suto T, Hirasawa H, Tsushima Y. Contrast-induced anaphylaxis: does it occur in the medical environment and is it being responded to appropriately? Jpn J Radiol 2023; 41:1022-1028. [PMID: 37040026 DOI: 10.1007/s11604-023-01427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To analyze the appropriateness of primary response for anaphylaxis due to iodinated contrast media (ICM) or gadolinium-based contrast agents (GBCA). MATERIALS AND METHODS This retrospective study included all patients in whom intravenous contrast agents (five types of ICMs and four types of GBCAs) were administered at our hospital between April 2016 and September 2021. For the patients who developed anaphylaxis, we obtained data on the time records of contrast injection, anaphylaxis onset, and intramuscular adrenaline (epinephrine) administration. RESULTS Of the 76,555 ICM and 30,731 GBCA administrations, anaphylaxis occurred in 49 cases (0.05%), and in 48 cases (98.0%) the onset was within 30 min after administration with widely distributed times (median, 7.5 min; interquartile range, 4.5-10.8 min; max, 26 min). Intramuscular adrenaline administration was performed in 43 cases (87.8%), and this was done within five minutes after the onset in 37 cases (75.5%). Only in 24 cases (49.0%), there were time records of both the onset and adrenaline administration (if performed). CONCLUSION Anaphylaxis occurred within 30 min after contrast injection in the majority of the cases, but times were widely distributed. Only in 75.5% of cases, appropriate primary treatment was performed, and the importance of keeping exact time records in patients' charts should be re-emphasized.
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Affiliation(s)
- Yasuhiro Fukushima
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hiromi Hirasawa
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Pałgan K. Mast Cells and Basophils in IgE-Independent Anaphylaxis. Int J Mol Sci 2023; 24:12802. [PMID: 37628983 PMCID: PMC10454702 DOI: 10.3390/ijms241612802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Anaphylaxis is a life-threatening or even fatal systemic hypersensitivity reaction. The incidence of anaphylaxis has risen at an alarming rate in the past decades in the majority of countries. Generally, the most common causes of severe or fatal anaphylaxis are medication, foods and Hymenoptera venoms. Anaphylactic reactions are characterized by the activation of mast cells and basophils and the release of mediators. These cells express a variety of receptors that enable them to respond to a wide range of stimulants. Most studies of anaphylaxis focus on IgE-dependent reactions. The mast cell has long been regarded as the main effector cell involved in IgE-mediated anaphylaxis. This paper reviews IgE-independent anaphylaxis, with special emphasis on mast cells, basophils, anaphylactic mediators, risk factors, triggers, and management.
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Affiliation(s)
- Krzysztof Pałgan
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Ujejskiego 75, 85-168 Bydgoszcz, Poland
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Fukushima Y, Taketomi-Takahashi A, Suto T, Hirasawa H, Tsushima Y. Clinical features and risk factors of iodinated contrast media (ICM)-induced anaphylaxis. Eur J Radiol 2023; 164:110880. [PMID: 37187078 DOI: 10.1016/j.ejrad.2023.110880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To evaluate the clinical features and risk factors of iodinated contrast media (ICM)-induced anaphylaxis. METHODS This retrospective study included all patients undergoing contrast-enhanced computed tomography (CT) with intravenous ICM administration (iopamidol, iohexol, iomeprol, iopromide, ioversol) at our hospital between April 2016 and September 2021. Medical records of patients who experienced anaphylaxis were reviewed, and the multivariable regression model using generalized estimating equations was employed to eliminate the effect of intrapatient correlation. RESULTS Of the 76,194 ICM administrations (44,099 men [58 %] and 32,095 women; age, median, 68 years) to 27, 696 patients, anaphylaxis occurred in 45 cases in 45 different patients (0.06 % of administration and 0.16 % of patients), all with onset within 30 min after administration. Thirty-one (69 %) had no risk factors for ADRs, including 14 (31 %) who had previously used the same ICM that caused anaphylaxis. Thirty-one patients (69 %) had a history of ICM use without any ADRs. Four patients (8.9 %) received oral steroid premedication. The only factor associated with anaphylaxis was the type of ICM, with an odds ratio (OR) of 6.8 (p < 0.001) for iomeprol with iopamidol as a reference. No significant differences in OR of anaphylaxis were found for patients' age, sex, or premedication. CONCLUSION The overall incidence of anaphylaxis due to ICM was very low. More than half of the cases had no risk factors for ADRs and had no ADRs on past ICM administration, although the ICM type was associated with a higher OR.
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Affiliation(s)
- Yasuhiro Fukushima
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Hiromi Hirasawa
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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Hofmann AG, Shoumariyeh T, Domenig C, Skrabal F, Kovarik JJ. Abdominal Aortic Aneurysm Detection in Bioelectrical Impedance Cardiovascular Screenings-A Pilot Study. J Clin Med 2023; 12:jcm12113726. [PMID: 37297921 DOI: 10.3390/jcm12113726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Screening and diagnosing abdominal aortic aneurysms (AAA) are currently dependent on imaging studies such as ultrasound or computed tomography angiography. All imaging studies offer distinct advantages but also suffer from inherent limitations such as examiner dependency or ionizing radiation. Bioelectrical impedance analysis has previously been investigated with respect to its use in the detection of several cardiovascular and renal pathologies. The present pilot study assessed the feasibility of AAA detection based on bioimpedance analysis. In this single-center exploratory pilot study, measurements were conducted among three different cohorts: patients with AAA, end-stage renal disease patients without AAA, and healthy controls. The device used in the study, CombynECG, is an open-market accessible device for segmental bioelectrical impedance analysis. The data was preprocessed and used to train four different machine learning models on a randomized training sample (80% of the full dataset). Each model was then evaluated on a test set (20% of the full dataset). The total sample included 22 patients with AAA, 16 chronic kidney disease patients, and 23 healthy controls. All four models showed strong predictive performance in the test partitions. Specificity ranged from 71.4 to 100%, while sensitivity ranged from 66.7 to 100%. The best-performing model had 100% accuracy for classification when applied to the test sample. Additionally, an exploratory analysis to approximate the maximum AAA diameter was conducted. An association analysis revealed several impedance parameters that might possess predictive ability with respect to aneurysm size. AAA detection via bioelectrical impedance analysis is technically feasible and appears to be a promising technology for large-scale clinical studies and routine clinical screening assessments.
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Affiliation(s)
- Amun G Hofmann
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
| | - Tarik Shoumariyeh
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Domenig
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Falko Skrabal
- Institute of Cardiovascular & Metabolic Medicine, 8010 Graz, Austria
| | - Johannes J Kovarik
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
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Tan WA, Hong R, Gao F, Chua SJT, Keng YJF, Koh CH. Outpatient Myocardial Perfusion Imaging Scan for a Low-Risk Chest Pain Cohort From the Emergency Department: A Retrospective Analysis. Curr Probl Cardiol 2023; 48:101517. [PMID: 36455794 DOI: 10.1016/j.cpcardiol.2022.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Chest pain accounts for a significant attendances at emergency departments (ED). We examined the utility of early stress myocardial perfusion imaging (SMPI) for stratification of low-risk patients post-ED discharge. A retrospective audit was conducted of patients with chest pain and normal troponin-T (<30Ng/L), who were discharged with outpatient SMPI (median = 3 days post-ED discharge) between January 2018 to January 2020. 880 patients were included and followed up for 12 months. Outcomes measured were: 1) Cardiac events (CE) within 1 year of visit or 2) Significant coronary artery disease (CAD) - coronary angiography demonstrating ≥70% stenosis of epicardial vessels or coronary revascularization procedures performed. In the SMPI negative group, 2 of 802 patients (0.25%) had significant CEs and 11 patients (1.37%) were diagnosed with significant CAD. Of the 78 SMPI positive patients, 1 (1.28%) had a significant CE, while 24 had significant CAD. SMPI had a sensitivity of 65.8%, specificity of 93.7%, positive predictive value of 32.1% and a negative predictive value of 98.4% for predicting adverse CE. Early SMPI post-ED discharge demonstrated high negative predictive value in predicting CEs or significant CAD diagnosis at up to 1 year, suggesting that low-risk patients discharge from ED with early outpatient SMPI is a safe management option.
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Affiliation(s)
- Weixian Alex Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore.
| | - Rilong Hong
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Fei Gao
- National Heart Research Institute, National Heart Centre Singapore, Singapore
| | | | | | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Qiu L, Cui Q, Gong X, Zhou H. Anaphylaxis Following Contrast-Enhanced CT with Iodixanol: A Case Report and Literature Review. J Asthma Allergy 2023; 16:195-200. [PMID: 36721740 PMCID: PMC9884438 DOI: 10.2147/jaa.s386811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Background Iodixanol-induced anaphylactic reaction is a well-known adverse event of contrast agents, which are generally well-tolerated and reversible. Serious and fatal reactions such as anaphylactic shock after computed tomography (CT) enhancement have been described. However, there is no data on these events in the literature. Objective This report describes a case of a serious anaphylactic reaction, possibly related to iodixanol and provides an overview of case reports. Case Summary A 47-year-old women who experienced persistent abdominal pain for more than one month, was proposed of hiatal hernia with CT images taken two weeks previously and was admitted to the gastrointestinal surgery department. The patient underwent contrast-enhanced abdominal CT for the evaluation of multiple intraperitoneal hemodynamic features. A few minutes after abdominal enhanced CT scan, the patient was pale, sweating, had muscle tension and trembling, even coma and profound hypotension with 90/43 mm Hg. Immediately she was supported with oxygen inhalation, was treated with adrenaline subcutaneously, dexamethasone intravenously, and rapid intravenous drip of compound sodium chloride. Ten minutes later, the patient was in respiratory and cardiac arrest and the pupils were dilated. CPR and intermittant static push of 1 mg adrenaline were immediately carried. After endotracheal intubation, the patient's spontaneous heart rate and pupils recovered, and her blood pressure recovered to 105/53 mm Hg. It was suggested that the patient was suffering from iodixanol-induced anaphylactic shock and nephropathy, and she was transferred to the intensive care unit. Despite immediate treatment, the patient died. Conclusion A 47-year-old female patient with no history of allergies developed severe fatal anaphylactic shock after receiving iodixanol. Although contrast agents induced anaphylactoid/anaphylactic reactions do not often occur, clinicians should be conscious of the potentially serious anaphylactic reaction, which could lead to a life-threatening or fatal event.
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Affiliation(s)
- Lin Qiu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qihao Cui
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xuepeng Gong
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Haiyun Zhou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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Transient Pneumonitis as a Possible Adverse Reaction to the BNT162b2 COVID-19 mRNA Vaccine in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature. Case Rep Rheumatol 2022; 2022:3124887. [PMID: 36052104 PMCID: PMC9427306 DOI: 10.1155/2022/3124887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to rapid progress in vaccine development to prevent the spread of the disease. Although COVID-19 vaccines have excellent effectiveness in reducing morbidity and disease severity with minor adverse reactions, some patients develop late hypersensitivity events as autoimmune reactions such as rheumatoid arthritis, lupus nephritis, and vasculitis following COVID-19 vaccination. Herein, we describe a case of pneumonitis following COVID-19 mRNA vaccination in a patient with rheumatoid arthritis, which resolved spontaneously.
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Contrast Medium Hypersensitivity: A Large Italian Study with Long-Term Follow-Up. Biomedicines 2022; 10:biomedicines10040759. [PMID: 35453509 PMCID: PMC9028178 DOI: 10.3390/biomedicines10040759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 12/20/2022] Open
Abstract
Hypersensitivity reactions (HRs) to contrast media (CM) are a major problem. We compared differences of HRs to iodinated contrast media (ICM) versus gadolinium-based contrast media (GBCM), collecting data on prevalence, type, latency and severity. Secondly, the predisposition to perform new contrast tests, use of premedication and possible appearance of new reactions were explored in a long-term follow-up of 5 years. Clinical data, comorbidities, skin test (ST) results, re-exposure to CM procedures with any new reactions, premedication and CM used were collected. In a retrospective single-center study, 350 patients with mild to moderate HRs were enrolled. Asthma, food allergy, non-allergic drug hypersensitivity and neurologic disease were significantly more frequent in patients with HRs to GBCM compared to the high evidence of cardiovascular disease and history of cancer in patients with HRs to ICM. A marked delay in performing STs was reported by patients with negative results (66 months, p < 0.01). Iomeprol, iopamidol and gadobenic acid were the culprit CM most involved in HRs in patients with positive STs. During follow-up, 7.1% of responders reported new HRs to CM despite negative STs, premedication and infusion of alternative CM in most cases.
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12
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Chompunud Na Ayudhya C, Ali H. Mas-Related G Protein–Coupled Receptor-X2 and Its Role in Non-immunoglobulin E–Mediated Drug Hypersensitivity. Immunol Allergy Clin North Am 2022; 42:269-284. [PMID: 35469618 PMCID: PMC9674431 DOI: 10.1016/j.iac.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A diverse group of Food and Drug Administration-approved cationic drugs including antibiotics, neuromuscular blocking drugs, opioids, antidepressants, and radiocontrast media activate mast cells and cause hypersensitivity reactions by both an immunoglobulin E IgE-dependent and independent manner. The recent discovery that these drugs activate mast cells via the G protein-coupled receptor known as Mas-related GPCR-X2 (MRGPRX2) has represented a paradigm shift of how drug hypersensitivity reactions are viewed. This article provides an overview of the current status of the role of MRGPRX2 on non-IgE-mediated drug hypersensitivity. Potential risk factors and evaluation for suspected MRGPRX2-mediated drug reactions are also discussed.
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Affiliation(s)
| | - Hydar Ali
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA 19104, USA.
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13
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Kang HR, Jeong J, Brockow K. Diagnosis and Prevention of Hypersensitivity Reactions to Iodinated Contrast Media. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:348-360. [PMID: 35837820 PMCID: PMC9293596 DOI: 10.4168/aair.2022.14.4.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Abstract
Iodinated contrast media (ICM) have become one of the major causes of drug hypersensitivity reactions (HSRs) related to increasing numbers of ICM-based radiological imaging procedures. Strategies for diagnosing and preventing ICM-induced HSRs have not been uniformly standardized yet. However, advances have been made based on the results of recent research. A previous history of hypersensitivity to ICM is the most significant risk factor for developing HSR by ICM. Avoidance of culprit agents and premedication is the main strategy to prevent recurrences of HSRs in high-risk patients. In addition, we strongly recommend identifying sensitized ICM using skin tests to determine immunoglobulin E-mediated or delayed-type allergy and to guide the choice of an alternative contrast agent. ICM provocation test procedures have been established and are helpful in selected cases. In this paper, we review how to evaluate patients who have experienced immediate or delayed HSRs caused by ICM to minimize the risk of recurrence and discuss unmet needs that require further research.
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Affiliation(s)
- Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Drug Safety Center, Seoul National University Hospital, Seoul, Korea
| | - Jiung Jeong
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Drug Safety Center, Seoul National University Hospital, Seoul, Korea
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
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14
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van der Molen AJ, Dekkers IA, Bedioune I, Darmon-Kern E. A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol in more than 57,000 patients: part 1-intravenous administration. Eur Radiol 2022; 32:5532-5545. [PMID: 35312790 PMCID: PMC9279198 DOI: 10.1007/s00330-022-08636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intravenous (IV) administration of ioversol. MATERIALS AND METHODS A systematic literature search (1980-2021) of studies documenting IV use of ioversol and presence or absence of ADRs, HSRs, or PC-AKI was performed. Key information including patients' characteristics, indication and dose of ioversol, safety outcome incidence, intensity and seriousness were extracted. RESULTS Thirty-one studies (> 57,000 patients) were selected, including 4 pediatric studies. The incidence of ADRs in adults was reported in 12 studies from ioversol clinical development with a median (range) of 1.65% (0-33.3%), and 3 other studies with an incidence between 0.13 and 0.28%. The incidence of HSRs (reported in 2 studies) ranged from 0.20 to 0.66%, and acute events (4 studies) from 0.23 to 1.80%. Severe reactions were rare with a median (range) of 0 (0-4%), and none were reported among pediatric patients. The incidence of ADRs and HSRs with ioversol, especially those of severe intensity, was among the lowest in studies comparing different iodinated contrast media (ICM) of the same class. PC-AKI incidence was variable (1-42% in 5 studies); however, ioversol exposure per se did not increase the incidence. CONCLUSIONS When administered by the IV route, ioversol has a good safety profile comparable to that of other ICM within the same class, with a low incidence of severe/serious ADRs overall, and particularly HSRs. PC-AKI incidence does not seem to be increased compared to patients who did not receive ioversol. Further well-designed studies are warranted to confirm these results. KEY POINTS • Ioversol has a good safety profile in adult and pediatric patients when IV administered. • ADR and HSR incidence with ioversol, especially those of severe intensity, was among the lowest compared to other ICM. • IV administration of ioversol per se did not increase PC-AKI incidence.
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Affiliation(s)
- Aart J. van der Molen
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Ilona A. Dekkers
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Ibrahim Bedioune
- Clinical Development Department, Guerbet, Roissy CDG Cedex, France
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15
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Quoc QL, Bich TCT, Jang JH, Park HS. Recent update on the management of anaphylaxis. Clin Exp Emerg Med 2021; 8:160-172. [PMID: 34649404 PMCID: PMC8517462 DOI: 10.15441/ceem.21.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.
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Affiliation(s)
- Quang Luu Quoc
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Tra Cao Thi Bich
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
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16
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Thong BYH, Vultaggio A, Rerkpattanapipat T, Schrijvers R. Prevention of Drug Hypersensitivity Reactions: Prescreening and Premedication. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2958-2966. [PMID: 34366094 DOI: 10.1016/j.jaip.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023]
Abstract
Drug hypersensitivity reactions (DHR) are heterogeneous in their pathomechanisms, clinical presentation, severity, and outcomes. Novel DHR mechanisms, phenotypes, and endotypes have been described. The key to prevention from further exposure to the culprit drugs involves correct identification of the putative drug through a combination of in vitro and/or in vivo tests, accurate drug allergy labeling and reporting, and electronic decision support systems within electronic medical records to prevent future accidental prescribing. Prescreening and premedication, the focus of this review, may be a useful adjunct to preventive measures in certain situations. After an index immediate drug hypersensitivity reaction, prescreening may be useful in perioperative anaphylaxis, and iodinated (ICM) and gadolinium-based contrast media (GCM) where the culprit and potential alternative agents are skin tested. In certain nonimmediate DHR, pharmacogenomic prescreening may be used before prescribing high-risk drugs (eg, carbamazepine and allopurinol) where specific human-leukocyte antigen genotypes are associated with severe cutaneous adverse reactions. Premedication with antihistamine and systemic corticosteroids is another therapeutic strategy to prevent infusion reactions for certain biologicals and chemotherapeutic agents, in cases of perioperative anaphylaxis, ICM and GCM DHR, and clonal mast cell disorders. Rapid drug desensitization may also be used to induce temporary tolerance in situations where there are limited alternative drugs.
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Affiliation(s)
- Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
| | - Alessandra Vultaggio
- Immunoallergology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ticha Rerkpattanapipat
- Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rik Schrijvers
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
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17
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Tang R, Li Y, Qin L, Yan F, Yang GY, Chen KM. Phase retrieval-based phase-contrast CT for vascular imaging with microbubble contrast agent. Med Phys 2021; 48:3459-3469. [PMID: 33657645 DOI: 10.1002/mp.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The introduction of microbubble contrast agent into tissues can create significant phase shifts. Phase retrieval (PR)-based phase-contrast computed tomography (PCCT) is an imaging method for retrieving and reconstructing the phase shifts within an object. This study aimed to evaluate the feasibility of PR-based PCCT with microbubble contrast agent for vascular imaging. METHODS Projection phase-contrast images of individual microbubbles and a cluster of microbubbles were captured and compared. Contrast enhancement from microbubbles was evaluated by comparing to the gold standard iodine-based contrast agent in vitro. The arterial systems of 14 Sprague-Dawley rats were perfused with microbubbles or saline. The rat hearts and the arterial systems were excised and imaged ex vivo. CT imaging was performed at the energy of 22 keV. PR was performed using the phase-attenuation duality (PAD) method with different δ/β values (PAD property). The contrast-to-noise ratio (CNR) was used for quantitatively assessing the contrast enhancement. RESULTS Individual microbubbles functioned as a lens to focus the x rays, whereas, a cluster of microbubbles scattered the x rays. In the in vitro experiment, the contrast enhancement from iodine was significantly greater than that from microbubbles (P < 0.05). In the heart samples, the CNRs for microbubbles on PR-based PCCT were significantly greater than those on absorption-contrast CT (ACCT) and PR-free PCCT (both P < 0.001). The CNRs for microbubbles were also significantly greater than those for saline on PR-based PCCT in the samples (P < 0.001). Although they provided weaker contrast enhancement than that from iodine, microbubbles could still provide sufficient contrast enhancement to clearly show the 3D architecture of rat aortas and their main branches. CONCLUSION The imaging modality can currently be used as a complement or alternative to absorption-based microCT for imaging vessels in biological samples.
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Affiliation(s)
- Rongbiao Tang
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University, and School of Medicine, Shanghai, China
| | - Yongfang Li
- Department of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University, and School of Medicine, Shanghai, China
| | - Le Qin
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University, and School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University, and School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ke-Min Chen
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University, and School of Medicine, Shanghai, China
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18
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Blumenthal KG, Robinson LB, Camargo CA, Shenoy ES, Banerji A, Landman AB, Wickner P. Acute Allergic Reactions to mRNA COVID-19 Vaccines. JAMA 2021; 325:1562-1565. [PMID: 33683290 PMCID: PMC7941251 DOI: 10.1001/jama.2021.3976] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/02/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Kimberly G. Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
| | - Lacey B. Robinson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Erica S. Shenoy
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
| | - Adam B. Landman
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, Massachusetts
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19
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Benzon HT, Maus TP, Kang HR, Provenzano DA, Bhatia A, Diehn F, Nelson A, McCormick ZL, Liu BP, de Andres Ares J, Anitescu M, Blackham K, Bhaskar A, Brill S, Collins J, Gulve A, Hurley RW, Jeon YH, Moon JY, Rauck RL, Rodes M, Lee RK, Shah V, Shanthanna H, van Zundert J, Huntoon M, Rathmell JP, Borges MS, Cohen SP, Greenberger PA. The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions. Anesth Analg 2021; 133:535-552. [PMID: 33755647 DOI: 10.1213/ane.0000000000005443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This Practice Advisory presents a comprehensive and evidence-based set of position statements and recommendations for the use of contrast media in interventional pain procedures. The advisory was established by an international panel of experts under the auspices of 11 multinational and multispecialty organizations based on a comprehensive review of the literature up to December 31, 2019. The advisory discusses the risks of using gadolinium-based contrast agents. These include nephrogenic systemic fibrosis, gadolinium brain deposition/retention, and encephalopathy and death after an unintentional intrathecal gadolinium injection. The advisory provides recommendations on the selection of a specific gadolinium-based contrast agent in patients with renal insufficiency, those who had multiple gadolinium-enhanced magnetic resonance imaging examinations, and in cases of paraspinal injections. Additionally, recommendations are made for patients who have a history of mild, moderate, or severe hypersensitivity reactions to contrast medium.
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Affiliation(s)
- Honorio T Benzon
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy P Maus
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Hye-Ryun Kang
- Department of Medicine (Allergy and Immunology), Seoul National University, Seoul, South Korea
| | | | - Anuj Bhatia
- Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada
| | - Felix Diehn
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ariana Nelson
- Department of Anesthesiology, University of California at Irvine, Irvine, California
| | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Benjamin P Liu
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Kristine Blackham
- Department of Radiology, University Hospital, Basel, Basel, Switzerland
| | - Arun Bhaskar
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Silviu Brill
- Institute of Pain Medicine, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Jeremy Collins
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ashish Gulve
- Department of Pain Management, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Robert W Hurley
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Young Hoon Jeon
- Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Jee Youn Moon
- Department of Anesthesiology, Seoul National University, Seoul, South Korea
| | | | - Meghan Rodes
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ryan K Lee
- Department of Radiology, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vinil Shah
- Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Harsha Shanthanna
- Department of Anesthesiology, McMaster University, Hamilton, Ontario, Canada
| | - Jan van Zundert
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Huntoon
- Department of Anesthesiology, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia
| | - James P Rathmell
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mario Sanchez Borges
- Department of Allergy and Clinical Immunology, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Department of Physical Medicine and Rehabilitation, and Department of Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Paul A Greenberger
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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20
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HLA-DRB1*15: 02 Is Associated With Iodinated Contrast Media-Related Anaphylaxis. Invest Radiol 2021; 55:304-309. [PMID: 31985601 DOI: 10.1097/rli.0000000000000644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of severe reaction induced by iodinated contrast media (ICM) has increased over the years with an increasing use of imaging modalities. Although ICM anaphylaxis is rare, it can be life-threatening, but currently, there is no biomarker that can identify individuals at risk of ICM anaphylaxis. OBJECTIVE The aim of this study is to investigate the genetic susceptibility of ICM anaphylaxis. METHODS Patients who had ICM anaphylaxis were enrolled in the study, and their blood samples were collected for genotyping of human leukocyte antigen (HLA)-A, -B, -C, and -DR. The results were compared with those of healthy Korean general population. MRGPRX2 gene in ICM anaphylaxis group was also sequenced and compared with the Korean standard database of genetic polymorphism. RESULTS The frequencies of 3 HLA alleles (B*52:01, C*12:02, and DRB1*15:02) were significantly higher in 47 patients with ICM anaphylaxis. In particular, HLA-DRB1*15:02 was 5 times more frequent in the ICM anaphylaxis group than the Korean general population (34.0% vs 6.6%; odds ratio, 7.306; 95% confidence interval, 3.622-14.740), and this difference was most pronounced in subjects with iohexol-induced anaphylaxis (odds ratio, 16.516; 95% CI, 5.241-52.047; P < 0.0001). Eight single nucleotide polymorphisms were identified in MRGPRX2 gene, but their frequencies were not different in those with ICM anaphylaxis compared with the general Korean population. CONCLUSIONS HLA-DRB1*15:02 is associated with ICM anaphylaxis in the Korean population.
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21
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Ugajin M, Ishiguro N, Kani H, Hattori H. A Case of Alveolar Haemorrhage Induced by Iodinated Contrast Medium Use. Eur J Case Rep Intern Med 2020; 7:001744. [PMID: 32908834 DOI: 10.12890/2020_001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/05/2022] Open
Abstract
An 81-year-old man complaining of exertional dyspnoea underwent coronary angiography using an iodinated contrast medium. After angiography, the patient required systemic corticosteroid therapy because of respiratory failure due to alveolar haemorrhage. Percutaneous coronary intervention was performed 29 days after angiography using the same contrast medium. After the intervention, the patient required intubated mechanical ventilation and renal replacement therapy. Bronchoalveolar lavage was bloody with many haemosiderin-filled macrophages. Systemic corticosteroid therapy again improved his clinical condition. Iodinated contrast media may cause alveolar haemorrhage and re-exposure to contrast media may induce a more severe adverse reaction. LEARNING POINTS Iodinated contrast media may cause alveolar haemorrhage.Re-exposure to iodinated contrast media may induce a more severe adverse reaction.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Nobuo Ishiguro
- Department of Cardiovascular Medicine, Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Hisanori Kani
- Department of Thoracic Surgery, Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Hideo Hattori
- Department of Pathology, Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
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22
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Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ, De Wulf A, Grover J, Papadimos TJ, Bloem C, Galwankar SC, Chauhan V, Firstenberg MS, Di Somma S, Jeanmonod D, Garg SM, Tucci V, Anderson HL, Fatimah L, Worlton TJ, Dubhashi SP, Glaze KS, Sinha S, Opara IN, Yellapu V, Kelkar D, El-Menyar A, Krishnan V, Venkataramanaiah S, Leyfman Y, Saoud Al Thani HA, WB Nanayakkara P, Nanda S, Cioè-Peña E, Sardesai I, Chandra S, Munasinghe A, Dutta V, Dal Ponte ST, Izurieta R, Asensio JA, Garg M. The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper. J Glob Infect Dis 2020; 12:47-93. [PMID: 32773996 PMCID: PMC7384689 DOI: 10.4103/jgid.jgid_86_20] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a "new normal" are discussed in this article.
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Affiliation(s)
- Stanislaw P Stawicki
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA,Address for correspondence: Dr. Stanislaw P Stawicki, Department of Research and Innovation, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, Pennsylvania, USA. E-mail:
| | - Rebecca Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Andrew C Miller
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Lorenzo Paladino
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - David F Gaieski
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Anna Q Yaffee
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Annelies De Wulf
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Joydeep Grover
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Thomas J. Papadimos
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Christina Bloem
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar C Galwankar
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vivek Chauhan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Michael S. Firstenberg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Salvatore Di Somma
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Donald Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Sona M Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Veronica Tucci
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Harry L Anderson
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Lateef Fatimah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Tamara J Worlton
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | - Krystal S Glaze
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar Sinha
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ijeoma Nnodim Opara
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Vikas Yellapu
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Dhanashree Kelkar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ayman El-Menyar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vimal Krishnan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - S Venkataramanaiah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Yan Leyfman
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | | | - Sudip Nanda
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Eric Cioè-Peña
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Indrani Sardesai
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Shruti Chandra
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Aruna Munasinghe
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vibha Dutta
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Silvana Teixeira Dal Ponte
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Ricardo Izurieta
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Juan A Asensio
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Manish Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
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Regateiro FS, Marques ML, Gomes ER. Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors. Int Arch Allergy Immunol 2020; 181:481-487. [PMID: 32396909 DOI: 10.1159/000507445] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022] Open
Abstract
Drug hypersensitivity is one of the most frequent causes of anaphylaxis, particularly in adults and in hospitalized patients. Drug-induced anaphylaxis (DIA) is also associated with more severe outcomes than other anaphylaxis triggers, and drugs are responsible for the majority of deaths due to anaphylaxis. We here review the current knowledge on the incidence, prevalence, drugs involved, mortality, and mortality risk factors for DIA. The incidence of both anaphylaxis and DIA seems to be increasing worldwide. Antibiotics and analgesics are the most frequently reported triggers of DIA. However, the importance of other drug groups should be taken into account, especially in particular settings (e.g., peri-operative and oncology). The identification of risk factors, geographical variables, and drugs associated with higher risk for DIA may improve the outcomes of this entity.
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Affiliation(s)
- Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, .,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal, .,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal,
| | - Maria Luís Marques
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Eva Rebelo Gomes
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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24
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Hsu Blatman KS, Sánchez-Borges M, Greenberger PA. Anaphylaxis in the Radiology Suite. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1203-1209. [DOI: 10.1016/j.jaip.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
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25
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Huynh K, Baghdanian AH, Baghdanian AA, Sun DS, Kolli KP, Zagoria RJ. Updated guidelines for intravenous contrast use for CT and MRI. Emerg Radiol 2020; 27:115-126. [PMID: 31925592 DOI: 10.1007/s10140-020-01751-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/03/2020] [Indexed: 12/29/2022]
Abstract
Intravenous (IV) contrast material is used extensively for CT and MRI scans done in emergency departments (ED). Its use is essential to make many critical diagnoses in ED patients. While adverse reactions can occur, newer research has added to our knowledge of IV contrast media tolerance and safety leading to improved and more liberal guidelines for intravenous contrast use. The updated information described in this review article indicates how intravenous contrast can be used safely in more patients, more expeditiously and with fewer precautions than with prior guidelines. This review article explains the basis for the new recommendations for intravenous contrast material use and describes indicated precautions and preparations to avoid adverse reactions for iodinated agents used for CT and gadolinium agents for MRI.
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Affiliation(s)
- Kevin Huynh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Arthur H Baghdanian
- Department of Radiology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Armonde A Baghdanian
- Department of Radiology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Derek S Sun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Ronald J Zagoria
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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26
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Cho MK, Lee SY, Kang HR. Recent updates of iodinated contrast media hypersensitivity. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.3.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min-Kyoung Cho
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hye-Ryun Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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27
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Nelson AJ, Ardissino M, Psaltis PJ. Current approach to the diagnosis of atherosclerotic coronary artery disease: more questions than answers. Ther Adv Chronic Dis 2019; 10:2040622319884819. [PMID: 31700595 PMCID: PMC6826912 DOI: 10.1177/2040622319884819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/03/2019] [Indexed: 01/10/2023] Open
Abstract
Despite its commonality in routine clinical practice, the approach to a diagnosis of atherosclerotic coronary artery disease remains complex and, in part, contentious. The traditional dogma linking ischaemia to hard clinical outcomes has been questioned and reframed over the years; rather than being a predictor of hard clinical outcomes, the degree of ischaemia may simply be a marker of atherosclerotic disease burden. A renewed interest in the imaging of plaque burden has spawned the contemporary role of CT imaging for not only diagnosis and prognosis, but also for dictating downstream management. As the technology develops and evidence expands, decisions on investigative modalities remain centred around patient factors, local availability, test performance and cost. This review summarizes the available methods for diagnosis in the symptomatic patient and provides an overview of the current evidence behind functional and anatomical approaches.
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Affiliation(s)
- Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, USA
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Maddalena Ardissino
- Duke Clinical Research Institute, Durham, NC, USA
- School of Medicine, Imperial College, London, UK
| | - Peter J. Psaltis
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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28
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Premedication for Iodinated Contrast Media Induced Immediate Hypersensitivity Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00224-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Purpose of the review
Premedication using antihistamines and/or corticosteroids has been widely used to prevent reoccurrence of immediate hypersensitivity reactions (iHR) after iodinated contrast media (ICM). However, efficacy has been debated, especially in high-risk patients. Novel findings on the role and risks of premedication and preventive strategies are summarized.
Recent findings
The rate and severity of iHR occurring despite premedication indicate that premedication is not a panacea and the intensity usually reflects that of the initial reaction. Next, the number needed to treat (NNT) to prevent one serious ICM-mediated event using corticosteroid-based premedication is high and associated with a diagnostic delay. Randomly changing the ICM has been suggested as an additional preventive measure, whilst others used a skin test–based approach to identify a subgroup of ICM allergic patients and negative skin test–based alternatives with a high negative predictive value.
Summary
Growing evidence indicates the need to discriminate between non-allergic iHR that are most likely non-obligatory and susceptible to premedication, and rare type I allergic iHR that can be identified using skin testing, especially in those with a severe iHR. Although premedication reduces reoccurrence of mild iHR, it is not always efficacious and should be balanced against side effects, a high NNT and an uncertain efficacy physicians should not blindly rely on. Future work should evaluate combined approaches of an allergy-driven ICM selection and endotype-driven premedication regimens in patients with non-allergic iHR.
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29
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Cha MJ, Kang DY, Lee W, Yoon SH, Choi YH, Byun JS, Lee J, Kim YH, Choo KS, Cho BS, Jeon KN, Jung JW, Kang HR. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients. Radiology 2019; 293:117-124. [PMID: 31478801 DOI: 10.1148/radiol.2019190485] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Multicenter studies may be required for establishing guidelines for safe usage of iodinated contrast media (ICM). Purpose To identify the prevalence, patterns, risk factors, and preventive measures for ICM-related hypersensitivity reactions (HSRs). Materials and Methods Between March 2017 and October 2017, a total of 196 081 patients who underwent ICM administration were enrolled from seven participating institutions. The occurrence of HSRs and baseline patient information were recorded. χ2 and Student t test were performed, and logistic regression analyses were used to identify risk factors that predict occurrence and recurrence of HSR. Results Among 196 081 patients (mean age ± standard deviation, 59.1 years ± 16.0; 105 014 men and 91 067 women) who underwent ICM administration, the overall prevalence of HSRs was 0.73% (1433 of 196 081), and severe reactions occurred in 0.01% (17 of 196 081). Conditional logistic regression for patients with HSR (n = 1433) and a control group (1:1 matched group for age, sex, ICM product, and institution) demonstrated that a patient's previous individual history of an ICM-related HSR (adjusted odds ratio [OR], 198.8; P < .001), hyperthyroidism (adjusted OR, 3.6; P = .04), drug allergy (adjusted OR, 3.5; P < .001), and other allergic diseases (adjusted OR, 6.8; P < .001) and a family history of ICM-related HSRs (adjusted OR, 14.0; P = .01) were predictors of HSR occurrence. Logistic regression analysis showed that use of premedication with antihistamine (OR, 0.5; P = .01) and change in the generic profile of ICM (OR, 0.5; P < .001) were preventive against recurrent HSR. Conclusion Family history as well as previous individual history of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) were risk factors for HSR occurrence, suggesting a potential genetic predisposition. A change in the culprit ICM and premedication with antihistamine are useful for reducing the recurrence of HSRs. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Min Jae Cha
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Dong Yoon Kang
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Whal Lee
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Soon Ho Yoon
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Young Hun Choi
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Jun Soo Byun
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Jongmin Lee
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Yun-Hyeon Kim
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Ki Seok Choo
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Bum Sang Cho
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Kyung Nyeo Jeon
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Jae-Woo Jung
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
| | - Hye-Ryun Kang
- From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.)
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30
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Lee JH, Kwon OY, Park SY, Seo B, Won HK, Kang Y, An J, Kwon HS, Song WJ, Cho YS, Moon HB, Yong HS, Hur GY, Kim TB. Validation of the Prescreening Intradermal Skin Test for Predicting Hypersensitivity to Iodinated Contrast Media: A Prospective Study with ICM Challenge. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:267-272. [PMID: 31408712 DOI: 10.1016/j.jaip.2019.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The number of hypersensitivity reactions associated with iodinated contrast media (ICM) is increasing with widespread use of radiographic contrast agents. These hypersensitivity reactions are unpredictable and sometimes lead to severe reactions such as anaphylaxis. OBJECTIVE To investigate the value of intradermal skin test (IDT) as a clinical screening tool for prediction of a hypersensitivity reaction to ICM. METHODS We performed IDT in the patients scheduled to receive an iodinated contrast agent between September 2015 and April 2017. After IDT, the contrast agent tested was administered intravenously, regardless of the results of skin testing, and the patients were carefully monitored. RESULTS We recruited 2,918 patients in 2 hospitals, and 2,843 were included in the final analysis. Fifteen (0.5%) of the 2843 patients had a positive IDT result before scheduled computed tomography scan; however, none of these patients experienced a hypersensitivity reaction after the administration of a full dose of ICM. Meanwhile, 19 patients who experienced hypersensitivity reactions after ICM challenge had showed a negative IDT result. The sensitivity and the positive predictive value of IDT for ICM were both 0%. CONCLUSIONS Routine IDT before the administration of an iodinated contrast agent does not predict hypersensitivity considering its extremely low sensitivity and a low positive predictive value.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Young Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Young Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Bomi Seo
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha-Kyeong Won
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yewon Kang
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin An
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gyu-Young Hur
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Maloney E, Iyer RS, Phillips GS, Menon S, Lee JJ, Callahan MJ. Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions. Pediatr Radiol 2019; 49:433-447. [PMID: 30923875 DOI: 10.1007/s00247-018-4306-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing "yes" responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - John J Lee
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
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Optimization of 3D phase contrast venography for the assessment of the cranio-cervical venous system at 1.5 T. Neuroradiology 2019; 61:293-304. [PMID: 30607475 DOI: 10.1007/s00234-018-2146-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this work was to optimize a three-dimensional (3D) phase-contrast venography (PCV) product MR pulse sequence in order to obtain clinically reliable images with less artifacts for an improved depiction of the cranio-cervical venous vessels. METHODS Starting from the product sequence, the 3D PCV protocol was optimized in eight steps with respect to the velocity encoding (Venc) direction and value, slice thickness, reduction of susceptibility artifacts and arterial contamination, gradient mode and radio-frequency (RF)-spoiling, B0-Shimming, asymmetric echo technique and RF-pulse type, and flip angle. The product and optimized protocol was used to perform 3D PCV in 12 healthy male volunteers with a median age of 50 years using a state-of-the-art 1.5-T MR system. For evaluation, the cranio-cervical venous system was divided into 15 segments. These segments were evaluated by three radiologists with experience in neuroradiology. An ordinal scoring system was used to access the overall diagnostic quality, arterial contamination, and the quality of visualization. RESULTS Image quality in the optimized 3D PCV was graded as "excellent" by all readers in 65.3% of the cases (p < 0.0001). The visualization of venous segments was strongly improved: it was considered diagnostic in 81.8% of all cases using the optimized sequence and in 47.6% for the product 3D PCV (p < 0.0001), respectively. The optimized protocol improved the imaging of all venous segments (p < 0.0001). CONCLUSION The optimized 3D PCV pulse sequence showed superior results compared to the product 3D PCV for the visualization and evaluation of the venous system in all healthy volunteers.
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Sánchez-Borges M, Aberer W, Brockow K, Celik GE, Cernadas J, Greenberger PA, Masse MS, Schrijvers R, Trautmann A. Controversies in Drug Allergy: Radiographic Contrast Media. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:61-65. [PMID: 30573421 DOI: 10.1016/j.jaip.2018.06.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/12/2022]
Abstract
The risk for developing immediate or delayed hypersensitivity reactions to radiocontrast media (RCM) interferes with the diagnosis and treatment of a number of patients requiring imaging diagnostic methods for many common diseases. A group of experts met in Orlando, Florida, in March 2018 to analyze the similarities and differences in the management of RCM reactions in different areas of the world. This paper presents a summary of the recommendations provided by this consensus group, highlighting controversial issues and unmet needs that require further research.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad and Clínica El Avila, Caracas, Venezuela.
| | - Werner Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | - Gulfem E Celik
- Department of Chest Diseases, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Josefina Cernadas
- Department of Allergy and Clinical Immunology, Medical University, H. S. Joao, Porto, Portugal
| | - Paul A Greenberger
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Marie-Soleil Masse
- Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Rik Schrijvers
- Laboratory of Clinical Immunology, Department of Microbiology and Clinical Immunology, KU Leuven, Leuven, Belgium
| | - Axel Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
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Clement O, Dewachter P, Mouton-Faivre C, Nevoret C, Guilloux L, Bloch Morot E, Katsahian S, Laroche D, Audebert M, Benabes-Jezraoui B, Benoit Y, Beot S, Berard F, Berthezene Y, Bertrand P, Bouffard J, Bourrain JL, Boyer B, Carette MF, Caron-Poitreau C, Cavestri B, Cercueil JP, Charpin DA, Collet E, Crombe-Ternamian A, Dalmas J, Decoux E, Defrance MF, Delaval Y, Demoly P, Depriester C, Depriester P, Didier A, Drouet M, Dupas B, Dupre-Goetchebeur D, Dzviga C, Fabre C, Ferretti G, Fourre-Jullian C, Girardin P, Giron J, Gouitaa M, Grenier N, Guenard Bilbault L, Guez S, Gunera-Saad N, Heautot JF, Herbin D, Hoarau C, Jacquot C, Julien C, Laborie L, Lambert C, Larroche P, Leclerc X, Lemaitre L, Leynadier F, Lillo-Le-Louet A, Louvel JP, Louvier N, Lucas MM, Meites G, Mennesson N, Metge L, Meunier Y, Monnier-Cholley L, Musacchio M, Nicolie B, Occelli G, Oesterle H, Paisant-Thouveny F, Panuel M, Railhac N, Rety-Jacob F, Rochefort-Morel C, Roy C, Sarlieve P, Sesay M, Sgro C, Taourel P, Terrier P, Theissen O, Topenot I, Valfrey J, Veillon F, Vergnaud MC, Veyret C, Vincent D, Wallaert B, Wessel F, Zins M. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study. EClinicalMedicine 2018; 1:51-61. [PMID: 31193689 PMCID: PMC6537532 DOI: 10.1016/j.eclinm.2018.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors. METHODS Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT. FINDINGS Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups. INTERPRETATION Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.
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Affiliation(s)
- Olivier Clement
- Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France
- Inserm U970 Université Paris Descartes Sorbonne Paris Cité, Laboratoire Imagerie 56 rue Leblanc Paris, FR 75015, France
- Corresponding author at: Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France
| | - Pascale Dewachter
- Assistance Publique Groupe Hospitalier de Paris-Seine Saint Denis, Université Paris Descartes Sorbonne Paris Cité, Anesthésie-Réanimation Chirurgicale, Bondy, FR 93140, France
| | - Claudie Mouton-Faivre
- CHU Nancy-Brabois, Bâtiment Philippe Canton Rue du Morvan, Vandoeuvre-lès-Nancy, FR 54511, France
| | - Camille Nevoret
- Hôpital Européen Georges Pompidou, Unité d'épidémiologie et de recherche clinique Paris, FR 75015, France
| | - Laurence Guilloux
- Laboratoire Biomnis, Immuno Allergologie, 17/19 avenue Tony Garnier Lyon, FR 69357, France
| | - Evelyne Bloch Morot
- Assistance Publique Hôpital Européen Georges Pompidou, Médecine Interne Allergologie Paris, FR 75015, France
| | - Sandrine Katsahian
- Assistance Publique Hôpital Européen Georges Pompidou, Unité d'épidémiologie et de recherche clinique Paris, FR 75015, France
| | - Dominique Laroche
- Centre Hospitalier Universitaire de Caen, Laboratoire d'Hormonologie Caen cedex 9, FR 14033, France
- Université de Caen Basse-Normandie, UFR de Médecine Caen, FR 14000, France
| | | | | | | | - Yves Benoit
- Unité d'Allergologie-Anesthésie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Sylvie Beot
- Service de Radiologie, CHU Brabois, Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Frédéric Berard
- Service d'Immunologie clinique et Allergologie, Pavillon 5 F, Centre Hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite Cedex, France
| | - Yves Berthezene
- Service d'Imagerie Médicale, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Philippe Bertrand
- Service de Radiologie, CHU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours Cedex, France
| | - Juliette Bouffard
- Service de Radiologie et Imagerie Médicale, Pavillon 3 B, Centre Hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre Benite Cedex, France
| | - Jean-Luc Bourrain
- Département pluridisciplinaire de médecine, Service de Dermatologie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Bruno Boyer
- Service de Radiologie, Centre Alexis Vautrin, 6 avenue de Bourgogne, 54 511 Vandoeuvre cedex, France
| | - Marie-France Carette
- Centre d’Allergologie, Hôpital TENON, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Christine Caron-Poitreau
- CHRU Angers, Hôpital Hôtel Dieu, Service de Radiologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Béatrice Cavestri
- Service de Pneumologie du Pr André-Bernard Tonnel, Hôpital Calmette, Boulevard du Professeur Leclerc, 59037 Lille cedex, France
| | - Jean Pierre Cercueil
- Service de Radiologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, BP 77908, 21034 Dijon Cedex, France
| | - Denis-André Charpin
- Service de Pneumologie- Allergologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Evelyne Collet
- Service de Dermatologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, 21034 Dijon Cedex, France
| | - Arielle Crombe-Ternamian
- Service de Radiologie digestive, Pavillon H, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jacques Dalmas
- Service d'Imagerie Médicale, Centre Hospitalier de Martigues, 3 bd des Rayettes, BP 50248, 13698 Martigues Cedex, France
| | - Eric Decoux
- Service de Radiologie, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Marie-France Defrance
- Service de Médecine Interne, Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75674 Paris Cedex 14, France
| | - Yvonne Delaval
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Pascal Demoly
- Service d'Allergologie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, 371 Av Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Claude Depriester
- Service d'Imagerie Médicale, Polyclinique du Bois, 44 avenue Marx Dormoy, 59000 Lille, France
| | | | - Alain Didier
- Service de Pneumologie, CHU de Toulouse, Hôpital Larrey, 24 chemin de Pouvourville, 31059 Toulouse Cedex 9, France
| | - Martine Drouet
- CHRU Angers, Hôpital Hôtel Dieu, Laboratoire d'Allergologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Benoît Dupas
- Service de Radiologie, CHU de Nantes, Hôpital Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes Cedex 01, France
| | | | - Charles Dzviga
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raymond, 42055 Saint Etienne Cedex 2, France
| | - Christine Fabre
- Service de Pneumologie, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30029 Nîmes Cedex 9, France
| | - Gilbert Ferretti
- Service Central de Radiologie et d' Imagerie Médicale, CHU Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Corinne Fourre-Jullian
- Service de Pneumo-allergologie, Centre Hospitalier de Martigues, 3 bd des Rayettes, BP 248, 13698 Martigues Cedex, France
| | - Pascal Girardin
- Service de Dermatologie II, Hôpital Saint-Jacques, 2 Place Saint-Jacques, 25030 Besancon Cedex, France
| | - Jacques Giron
- Service Centrale d'Imagerie médicale, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - Marion Gouitaa
- Service de Pneumologie- Allergologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Nicolas Grenier
- Service de Radiologie B, Groupe Hospitalier Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Lydie Guenard Bilbault
- Service Immuno-Allergologie, Hôpital Central, 29, avenue Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France
| | - Stéphane Guez
- Unité des Maladies Allergiques, Groupe Hospitalier Pellegrin, Bâtiment PQR, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | | | - Jean-François Heautot
- Service de Radiologie, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France
| | - Dominique Herbin
- Service de Pneumologie, Centre hospitalier Louis Pasteur, 46, rue du val de saire, 50102 Cherbourg Cedex, France
| | - Cyrille Hoarau
- Service d'Immunologie Clinique et Néphrologie, CHRU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37 044 Tours Cedex, France
| | - Claude Jacquot
- Département d'Anesthésie Réanimation 1, CHU de Grenoble, Hôpital A.Michallon, BP 127, 38043 Grenoble Cedex 09, France
| | - Christian Julien
- Service d'imagerie médicale, Centre hospitalier Louis Pasteur, 46, rue du val de saire, 50 102 Cherbourg Cedex, France
| | - Laurent Laborie
- Service de Radiologie A, CHRU Jean Minjoz, 22, Bd A. Flemming, 25030 Besancon Cedex, France
| | - Claude Lambert
- Laboratoire Immunologie, Pavillon 5 bis, CHU de Saint-Etienne, Hôpital Bellevue, 42055 Saint Etienne Cedex 2, France
| | - Pascal Larroche
- Service de Radiologie, Hôpital de la Cavale blanche, Boulevard Tanguy Prigent, 29200 BREST Cedex, France
| | - Xavier Leclerc
- Service de Neuroradiologie, CHRU, Hôpital Roger Salengro, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - Laurent Lemaitre
- Plateau Commun d'Imagerie Médicale, Hôpital Claude Huriez, Rue Michel Polonovski, 59037 Lille Cedex, France
| | - Francisque Leynadier
- Centre d’Allergologie, Hôpital TENON, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Agnès Lillo-Le-Louet
- Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cedex 15, France
| | - Jean-Pierre Louvel
- Service de Radiologie, CHU de Rouen, Hôpital de Boisguillaume-147, avenue du Maréchal Juin, 76230, Boisguillaume, France
| | - Nathalie Louvier
- Service Anesthésie Réanimation, Centre Georges Francois Leclerc, 1 rue Professeur Marion, BP 77980, 21079 Dijon Cedex, France
| | - Marie-Madeleine Lucas
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Geneviève Meites
- Service de Radiologie, Hôpital Rangueil, 1, avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France
| | - Nicolas Mennesson
- Service de Radiologie digestive, Pavillon H, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Liliane Metge
- Département d'Imagerie Médicale, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30 029 Nimes Cedex 9, France
| | - Yannick Meunier
- Département d'Anesthésie Réanimation, CHU de Rouen, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen Cedex, France
| | - Laurence Monnier-Cholley
- Service de Radiologie, Hôpital Saint Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Mariano Musacchio
- Service de Radiologie, Hôpitaux civils, Hôpital Pasteur, Neuro Radiologie Pôle 3, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Brigitte Nicolie
- CHRU Angers, Hôpital Hôtel Dieu, Unité fonctionnelle d'allergologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Gisèle Occelli
- Service de Pneumologie, CHU de Nice, Hôpital Pasteur, H.O, 30, avenue de la Voie Romaine, 06100 Nice, France
| | - Hélène Oesterle
- Service de Radiologie, Hôpitaux civils, Hôpital Pasteur, Neuro Radiologie Pôle 3, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Francine Paisant-Thouveny
- CHRU Angers, Hôpital Hôtel Dieu, Service de Radiologie C, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Michel Panuel
- Service de Radiologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Nadine Railhac
- Service de Radiologie, Hl Purpan, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - Frédérique Rety-Jacob
- Service de Radiologie et Imagerie Médicale, Pavillon 3 B, Centre Hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre Benite Cedex, France
| | - Cécile Rochefort-Morel
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Catherine Roy
- Service de Radiologie B, Pavillon Chirurgical A, Hôpital Civil, 1 place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
| | - Philippe Sarlieve
- Service de Radiologie A et C, CHRU Jean Minjoz, 22, Bd A.Flemming, 25030 Besancon Cedex, France
| | - Musa Sesay
- Service de Radiologie, Groupe Hospitalier Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Catherine Sgro
- Service de Pharmacologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, 21034 Dijon Cedex, France
| | - Patrice Taourel
- Service de Radiologie A, CHU de Montpellier, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Patrick Terrier
- Service de Pneumologie, CHU de Rouen, Hôpital Charles Nicolle, 1, rue Germont, 76031 Rouen Cedex, France
| | - Odile Theissen
- Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux civils, Hôpital Pasteur, Pôle 2, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Ingrid Topenot
- Service de Dermatologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jocelyne Valfrey
- Département d'Anesthésie, Hôpital Lyautey, 1 rue des Canonniers, 67100 Strasbourg, France
| | - Francis Veillon
- Service de Radiologie 1, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Marie-Claude Vergnaud
- Service de médecine polyvalente, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Charles Veyret
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raymond, 42055 Saint Etienne Cedex 2, France
| | - Denis Vincent
- Service de Pneumologie – Médecine Interne, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30029 Nimes Cedex 9, France
| | - Benoit Wallaert
- Service de Pneumologie, CHR de Lille, Clinique des Maladies Respiratoires, RCO - Hôpital Calmette, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - François Wessel
- Service de Pneumologie, Hôpital G et R Laënnec, Bd Jacques Monod, 44093 Nantes Cedex 1, France
| | - Marc Zins
- Service de Médecine Interne, Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75674 Paris Cedex 14, France
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Schrijvers R, Breynaert C, Ahmedali Y, Bourrain JL, Demoly P, Chiriac AM. Skin Testing for Suspected Iodinated Contrast Media Hypersensitivity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1246-1254. [DOI: 10.1016/j.jaip.2017.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 09/10/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
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Reactions to Both Nonionic Iodinated and Gadolinium-Based Contrast Media: Incidence and Clinical Characteristics. AJR Am J Roentgenol 2018; 210:715-719. [DOI: 10.2214/ajr.17.18655] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Böhm I. Iodinated X-ray contrast media in aquatic environment in general and in drinking water in particular: A possible source for the primary sensitization of patients. CHEMOSPHERE 2018; 194:28-29. [PMID: 29195091 DOI: 10.1016/j.chemosphere.2017.11.154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/22/2017] [Accepted: 11/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern (Inselspital), University of Bern, Bern, Switzerland; Radiology Lab, Department of BioMedical Research, University of Bern, Bern, Switzerland.
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Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. Allergol Int 2018; 67:96-102. [PMID: 28602247 DOI: 10.1016/j.alit.2017.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/20/2017] [Accepted: 05/06/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anaphylaxis is a life-threatening allergic reaction. Several studies reported different anaphylactic reactions according to the causative substances. However, a comparison of anaphylaxis for each cause has not been done. This study was conducted to identify common causes of anaphylaxis, characteristics of anaphylactic reaction for each cause and to analyze the factors related to the severity of the reaction. METHODS Medical records of patients who visited the emergency room of Ewha Womans University Mokdong Hospital from March 2003 to April 2016 and diagnosed with anaphylactic shock were retrospectively reviewed. We compared the clinical features of anaphylaxis according to the cause. In addition, the severity of anaphylaxis was analyzed and contributing factors for severe anaphylaxis were reviewed. RESULTS A total of 199 patients with anaphylaxis were analyzed. Food was the most common cause (49.7%), followed by drug reaction (36.2%), bee venom (10.1%), and unknown cause (4.0%). Cardiovascular symptoms of syncope and hypotension were more common in drug-induced anaphylaxis. The incidence of severe anaphylaxis was the highest in anaphylaxis due to drugs (54.2%). Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis. Risk factors for severe anaphylaxis included older age, male, and drug-induced one. Epinephrine treatment of anaphylaxis was done for 69.7% and 56.9% of patients with food-induced and drug-induced anaphylaxis, respectively. CONCLUSIONS More severe anaphylaxis developed with drug treatment and in males. Low rate of epinephrine prescription was also observed. Male patients with drug induced anaphylaxis should be paid more attention.
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Drug-induced anaphylaxis in China: a 10 year retrospective analysis of the Beijing Pharmacovigilance Database. Int J Clin Pharm 2017; 40:1349-1358. [PMID: 29086147 PMCID: PMC6208584 DOI: 10.1007/s11096-017-0535-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022]
Abstract
Background Few studies on the causes of drug-induced anaphylaxis (DIA) in the hospital setting are available. Objective We aimed to use the Beijing Pharmacovigilance Database (BPD) to identify the causes of DIA in Beijing, China. Setting Anaphylactic case reports from the BPD provided by the Beijing Center for Adverse Drug Reaction Monitoring. Method DIA cases collected by the BPD from January 2004 to December 2014 were adjudicated. Cases were analyzed for demographics, causative drugs and route of administration, and clinical signs and outcomes. Main outcome measure Drugs implicated in DIAs were identified and the signs and symptoms of the DIA cases were analyzed. Results A total of 1189 DIA cases were analyzed. The mean age was 47.6 years, and 732 (61.6%) were aged from 18 to 59 years. A total of 627 patients (52.7%) were females. There was a predominance of cardiovascular (83.8%) followed by respiratory (55.4%), central nervous (50.1%), mucocutaneous (47.4%), and gastrointestinal symptoms (31.3%). A total of 249 different drugs were involved. DIAs were mainly caused by antibiotics (39.3%), traditional Chinese medicines (TCM) (11.9%), radiocontrast agents (11.9%), and antineoplastic agents (10.3%). Cephalosporins accounted for majority (34.5%) of antibiotic-induced anaphylaxis, followed by fluoroquinolones (29.6%), beta-lactam/beta-lactamase inhibitors (15.4%) and penicillins (7.9%). Blood products and biological agents (3.1%), and plasma substitutes (2.1%) were also important contributors to DIAs. Conclusion A variety of drug classes were implicated in DIAs. Patients should be closely monitored for signs and symptoms of anaphylaxis when medications are administered especially with antibiotics, TCM, radiocontrast and antineoplastic agents.
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Morales-Cabeza C, Roa-Medellín D, Torrado I, De Barrio M, Fernández-Álvarez C, Montes-Aceñero JF, De La Riva I, Prieto-García A. Immediate reactions to iodinated contrast media. Ann Allergy Asthma Immunol 2017; 119:553-557. [PMID: 29017901 DOI: 10.1016/j.anai.2017.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immediate hypersensitivity reactions (IHRs) to iodinated contrast media (ICMs) remain a common clinical concern. Positive skin test and basophil activation test results suggest a specific IgE-mediated mechanism in some cases. Skin test and controlled challenge test (CCT) are useful to manage these patients. OBJECTIVE To study clinical and allergologic features of IHRs to ICMs in a Spanish tertiary hospital during a 7-year period. METHODS Demographic and clinical data concerning the reaction were recorded. Patients treated at the Allergy Department of Hospital General Universitario Gregorio Marañón, Madrid, Spain, underwent skin tests. In those with positive results, CCTs with an alternative skin-test-negative ICM was performed. Global reaction rate was calculated and compared for each ICM. RESULTS A total of 342 reactions occurred in 329 patients. Cutaneous symptoms were the most common (87.7%). A total of 196 patients underwent an allergy workup, 15 (7.6%) of whom had positive skin test results. Reactions were more severe in patients with positive vs negative skin test results (grade 1, 46.7% vs 73.6%; grade 2, 33.3% vs 20.9%; grade 3, 20% vs 5.46%; P < .05). Three patients had cross-reactivity to 3 ICMs, all including ioversol and iomeprol. Six patients allergic to iopamidol tolerated ioversol and 1 tolerated iomeprol. Four patients allergic to ioversol and 1 allergic to iomeprol tolerated iopamidol. The global reaction rate was 0.2%, differing for each ICM (iopamidol, 0.14%; ioversol, 0.2%; and iomeprol, 0.4%; P < .001). Positive skin test results were found in a low percentage of patients in whom skin test-based CCT identified an alternative non-cross-reactive ICM. Low-grade cross-reactivity was found, especially between iopamidol and ioversol. Reactions were more severe in patients with positive skin test results. The reaction rate was greater for iomeprol compared with iopamidol (reaction rate, 2.8%) and ioversol (reaction rate, 2%). CONCLUSION This study identified a possible underlying specific IgE-mediated mechanism by positive skin test result in a low percentage of patients with IHRs to ICMs. In these patients, the CCT based on skin test results was useful for identifying an alternative non-cross-reactive ICM. More studies are needed to investigate the underlying mechanism in patients with IHRs and negative skin test results.
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Affiliation(s)
| | - Dasha Roa-Medellín
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inés Torrado
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel De Barrio
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Fernández-Álvarez
- Quality Service, Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Inmaculada De La Riva
- Quality Service, Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alicia Prieto-García
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Kim TH, Yoon SH, Lee SY, Choi YH, Park CM, Kang HR, Cho SH. Biphasic and protracted anaphylaxis to iodinated contrast media. Eur Radiol 2017; 28:1242-1252. [PMID: 28956131 DOI: 10.1007/s00330-017-5052-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/27/2017] [Accepted: 08/22/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the prevalence of biphasic and protracted anaphylaxis to iodinated contrast media (ICM), their risk factors and practical observation duration for detecting biphasic reaction. METHODS 145 patients with ICM anaphylaxis from January 2005-February 2016 were retrospectively categorised into uniphasic, biphasic (anaphylaxis recurrence within 72 h after resolution of initial anaphylaxis) and protracted (anaphylaxis >5 h) reaction groups. Multivariate regression analyses of potential risk factors were performed. We calculated negative predictive value (NPV) for biphasic reactions and additional person-hours required to detect one case during post-anaphylaxis observation. RESULTS Fifteen patients had biphasic reactions with secondary reactions with similar or milder severity and six had protracted reactions. Most significant risk factors were anaphylaxis duration >40 min for biphasic reactions (odds ratio (OR), 8.65 [95 % CI, 1.05-70.71]; P=0.044), and additional epinephrine administration within 1 h of initial dosing for protracted reactions (OR, 102.0 [95 % CI, 3.40-3057.25]; P=0.008). A 6-h post-anaphylaxis observation produced NPV of 96.4 %, while requiring a minimum of 65.5 additional person-hours to detect one additional case. CONCLUSION Biphasic and protracted ICM anaphylaxis developed in 10.3 % and 4.1 %, respectively, with revealing risk factors. Six hours could be practical for post-anaphylaxis observation to detect biphasic reaction. KEY POINTS • Incidence of biphasic anaphylaxis in iodinated contrast media anaphylaxis is 10.3 %. • Incidence of protracted anaphylaxis in iodinated contrast media anaphylaxis is 4.1 %. • Initial anaphylaxis >40 min can predict for biphasic anaphylaxis development. • A 6-h post-anaphylactic observation in ICM-related anaphylaxis seems practical.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Suh-Young Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Roper J, Fleming ME, Long B, Koyfman A. Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department. J Emerg Med 2017; 53:843-853. [PMID: 28916122 DOI: 10.1016/j.jemermed.2017.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common. MC is a clinical diagnosis defined by respiratory failure caused by exacerbation of MG. Muscle weakness can involve any voluntary muscle. MC can be differentiated from other neuromuscular junction diseases by the presence of normal reflexes, normal sensation, lack of autonomic symptoms, lack of fasciculations, and worsening weakness with repetitive motion. Treatment should target the inciting event and airway support. All acetylcholinesterase inhibitors should be avoided in crisis, including edrophonium testing and corticosteroids initially. Respiratory support can begin with noninvasive positive-pressure ventilation, as this has been successful even in patients with bulbar weakness. If intubation is necessary, consider avoiding paralytics or use a reduced dose of nondepolarizing agents. CONCLUSIONS MC should be in the differential of any patient with muscular weakness and respiratory compromise. Emergency department management of MC should focus on ruling out infection and respiratory support. Strong consideration should be given to beginning with noninvasive positive-pressure ventilation for ventilatory support. Corticosteroids, depolarizing paralytics, and acetylcholinesterase inhibitors should be avoided in patients with MC in the emergency department.
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Affiliation(s)
- Jamie Roper
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - M Emily Fleming
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Efficacy of double inversion recovery magnetic resonance imaging for the evaluation of the synovium in the femoro-patellar joint without contrast enhancement. Eur Radiol 2017; 28:459-467. [PMID: 28828623 DOI: 10.1007/s00330-017-5017-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the efficacy of double inversion recovery (DIR) sequence for evaluating the synovium of the femoro-patellar joint without contrast enhancement (CE). METHODS Two radiologists independently evaluated the axial DIR and CE T1-weighted fat-saturated (CET1FS) images of 33 knees for agreement; the visualisation and distribution of the synovium were evaluated using a four-point visual scaling system at each of the five levels of the femoro-patellar joint and the location of the thickest synovium. The maximal synovial thickness at each sequence was measured by consensus. RESULTS The interobserver agreement was good (κ = 0.736) for the four-point scale, and was excellent for the location of the thickest synovium on DIR and CET1FS (κ = 0.955 and 0.954). The intersequential agreement for the area with the thickest synovium was also excellent (κ = 0.845 and κ = 0.828). The synovial thickness on each sequence showed excellent correlation (r = 0.872). CONCLUSION The DIR showed as good a correlation as CET1FS for the evaluation of the synovium at the femoro-patellar joint. DIR may be a useful MR technique for evaluating the synovium without CE. KEY POINTS • DIR can be useful for evaluating the synovium of the femoro-patellar joint. • Interobserver and intersequential agreements between DIR and CET1FS were good. • Mean thickness of the synovium was significantly different between two sequences.
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Jung JW, Choi YH, Park CM, Park HW, Cho SH, Kang HR. Outcomes of corticosteroid prophylaxis for hypersensitivity reactions to low osmolar contrast media in high-risk patients. Ann Allergy Asthma Immunol 2017; 117:304-309.e1. [PMID: 27613465 DOI: 10.1016/j.anai.2016.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Corticosteroid prophylaxis has been widely adopted for the prevention of acute allergic-like reactions to iodinated contrast media, but its use is still controversial because there is no strong evidence supporting its efficacy before administration of nonionic low osmolar contrast media (LOCM). OBJECTIVE To assess the outcomes of premedication in patients with previous acute allergic-like reactions to LOCM in clinical practice. METHODS A retrospective study was performed on 322 high-risk patients who were reexposed to LOCM after premedication composed of antihistamines and/or systemic corticosteroids because of a previous history of acute allergic-like reactions to LOCM. RESULTS After premedication, 275 patients (85.4%) did not experience any reaction, but 47 patients (14.6%) still experienced a breakthrough reaction. The premedication rate and amount of corticosteroid administered were significantly higher in the nonrecurrence group than in the recurrence group (P = .04 and P = .04, respectively), and a linear trend was observed in the use of corticosteroid premedication and the efficacy of prevention (P for trend = .02). Multivariate binary logistic regression revealed that corticosteroid premedication was effective in preventing recurrence (odds ratio, 0.284; 95% confidence interval, 0.103-0.784). Nonetheless, despite corticosteroid premedication, 3.4% of high-risk patients still experienced moderate to severe reactions, and 14.3% of patients with a severe index reaction again had a severe reaction. CONCLUSION Premedication with corticosteroids seems to be helpful in reducing the overall rate of recurrence of acute allergic-like reactions to LOCM in high-risk patients, but patients with severe index reactions are still at risk of developing severe reactions despite corticosteroid premedication.
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Affiliation(s)
- Jae-Woo Jung
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology and Institute of Radiation Medicine, 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
| | - Heung Woo Park
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea.
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Abstract
UNLABELLED Hypersensitivity reactions to radiocontrast media (RCM) are common and in severe cases may present a challenge for treating physician in cases when premedication fails or the patient presents with severe comorbidities. We describe two cases in need of radiocontrast media after a severe reaction on previous exposure to iohexol. One presented anaphylactic reaction to RCM despite premedication and another presented with angina. Both cases were treated with a desensitization protocol to iodixanol. In conclusion, desensitization to radiocontrast media may be considered in patients with previously unsuccessful premedication and/or severe acute comorbidities. SIMILAR CASES PUBLISHED 14.
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Affiliation(s)
- Mona Al-Ahmad
- Mona Al-Ahmad, Department of Microbiology,, Faculty of Medicine, Kuwait University,, PO Box 24923,, Safat 13110, Kuwait, T: +965-24636515, F: +965-25332719, , ORCID: orcid.org/0000-0003-3720-7032
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Seecheran R, Seecheran V, Persad S, Lalla S, Seecheran NA. Contrast Media-Induced Anaphylaxis Causing a Stress-Related Cardiomyopathy Post Percutaneous Coronary Intervention: Case Report. J Investig Med High Impact Case Rep 2017; 5:2324709617712735. [PMID: 28607937 PMCID: PMC5455850 DOI: 10.1177/2324709617712735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023] Open
Abstract
Anaphylaxis is a sudden-onset, severe hypersensitivity reaction that can be potentially fatal. It can often transition to refractory hemodynamic instability, eventually resulting in death. Stress-related cardiomyopathies (SRCs) have multifactorial etiologies, including being linked to excessive catecholamine release in periods of intense stress. This novel case report recounts a SRC caused by contrast-induced anaphylaxis within 1 hour post percutaneous coronary intervention. Both acutely life-threatening conditions may occur simultaneously and are implicated with devastating complications. Further research is required to understand this cardiac-neuroaxis interplay in SRC to identify risk factors and develop management strategies.
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Affiliation(s)
- Rajeev Seecheran
- The University of the West Indies, Mt. Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- North West Regional Health Authority, Port-of-Spain, Trinidad and Tobago
| | - Sangeeta Persad
- North West Regional Health Authority, Port-of-Spain, Trinidad and Tobago
| | - Sasha Lalla
- Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Naveen Anand Seecheran
- The University of the West Indies, Mt. Hope, Trinidad and Tobago.,Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
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Montañez MI, Mayorga C, Bogas G, Barrionuevo E, Fernandez-Santamaria R, Martin-Serrano A, Laguna JJ, Torres MJ, Fernandez TD, Doña I. Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis. Front Immunol 2017; 8:614. [PMID: 28611774 PMCID: PMC5446992 DOI: 10.3389/fimmu.2017.00614] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/09/2017] [Indexed: 12/14/2022] Open
Abstract
Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators by mast cells and basophils. Although anaphylaxis is often under-communicated and thus underestimated, its incidence appears to have risen over recent decades. Drugs are among the most common triggers in adults, being analgesics and antibiotics the most common causal agents. Anaphylaxis can be caused by immunologic or non-immunologic mechanisms. Immunologic anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves activation of Th2 cells and the cross-linking of two or more specific IgE (sIgE) antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms. Work-up of a suspected drug-induced anaphylaxis should include clinical history; however, this can be unreliable, and skin tests should also be used if available and validated. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help to confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunologic mechanisms are suspected, serum-sIgE quantification or the use of the basophil activation test can help confirm the culprit drug. In this review, we will discuss multiple aspects of drug-induced anaphylaxis, including epidemiology, mechanisms, and diagnosis.
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Affiliation(s)
- Maria Isabel Montañez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | - Cristobalina Mayorga
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Gador Bogas
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Esther Barrionuevo
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | | | - Angela Martin-Serrano
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | | | - Maria José Torres
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain.,Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Tahia Diana Fernandez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Inmaculada Doña
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
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Hsu Blatman KS, Hepner DL. Current Knowledge and Management of Hypersensitivity to Perioperative Drugs and Radiocontrast Media. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:587-592. [DOI: 10.1016/j.jaip.2017.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/16/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
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