Anaphylactic shock with an ultrasound contrast agent

Coudray, Sarah; Fabre, C.; Aichoun, Isabelle; Perez-Martin, Antonia

doi:10.1016/j.jdmv.2017.10.001

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…As more evidence of Albunex's cardiopulmonary reactivity, it was reported to trigger a biphasic pulmonary response in a subgroup of cardiac patients withdrawn from anti-inflammatory medication [70]. The next-generation ultrasound contrast agents (SonoVue, Optison, and deFinity) continued to cause severe HSRs that led to their temporary or final suspension [71][72][73][74][75][76][77][78][79]. This reactogenicity can be modeled in pigs just like the reactogenicity of the drugs listed in Table 1 (unpublished data).…”

Section: The Issue Of Discordant Prevalence Of Hsrs In Pigs and Humansmentioning

confidence: 99%

Human Clinical Relevance of the Porcine Model of Pseudoallergic Infusion Reactions

Szebeni

Bawa

2020

Biomedicines

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Pigs provide a highly sensitive animal model for pseudoallergic infusion reactions, which are mild-to-severe hypersensitivity reactions (HSRs) that arise following intravenous administration of certain nanoparticulate drugs (nanomedicines) and other macromolecular structures. This model has been used in research for three decades and was also proposed by regulatory bodies for preclinical assessment of the risk of HSRs in the clinical stages of nano-drug development. However, there are views challenging the human relevance of the model and its utility in preclinical safety evaluation of nanomedicines. The argument challenging the model refers to the “global response” of pulmonary intravascular macrophages (PIM cells) in the lung of pigs, preventing the distinction of reactogenic from non-reactogenic particles, therefore overestimating the risk of HSRs relative to its occurrence in the normal human population. The goal of this review is to present the large body of experimental and clinical evidence negating the “global response” claim, while also showing the concordance of symptoms caused by different reactogenic nanoparticles in pigs and hypersensitive man. Contrary to the model’s demotion, we propose that the above features, together with the high reproducibility of quantifiable physiological endpoints, validate the porcine “complement activation-related pseudoallergy” (CARPA) model for safety evaluations. However, it needs to be kept in mind that the model is a disease model in the context of hypersensitivity to certain nanomedicines. Rather than toxicity screening, its main purpose is specific identification of HSR hazard, also enabling studies on the mechanism and mitigation of potentially serious HSRs.

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Section: The Issue Of Discordant Prevalence Of Hsrs In Pigs and Humansmentioning

confidence: 99%

Human Clinical Relevance of the Porcine Model of Pseudoallergic Infusion Reactions

Szebeni

Bawa

2020

Biomedicines

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“…Needle position may also be checked by ultrasound and (off label) injection of ultrasound contrast agent visualizing its lymphatic run-off 6 . While obviating the need for ionizing radiation and iodinated contrast agent, this technique may be associated with (rare) side effects of ultrasound contrast agent and its increased costs 9 .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided needle positioning for nodal dynamic contrast-enhanced MR lymphangiography

Wagenpfeil

Kupczyk

Henkel

et al. 2022

Sci Rep

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The aim of the study was to assess injection needle positioning for contrast-enhanced MR-lymphangiography (MRL) by ultrasound-guided injection of saline-solution. 80 patients (33 male, mean age 43.1 years) were referred for MRL. The injection needle position was assessed by injection of saline-solution. Consecutive lymph node distension was observed on sonography followed by MRL. Transpedal MRL was performed when no inguinal lymph nodes could be identified. The inguinal lymph node detection rate was recorded. MR-lymphangiograms were assessed regarding primary (i.e. enhancement of draining lymph vessels) and secondary technical success (i.e. lymph vessel enhancement after repositioning of the needle). MRL was considered as clinically successful if enhancement of the central lymphatic system and/or a lymphatic pathologies were observed. For a total of 92 MRLs 177 groins were evaluated sonographically. In 171/177 groins (96.6%) lymph nodes were identified. After needle placement lymph node distension was observed in 171/171 cases (100%) on saline injection. MR-contrast injection demonstrated enhancement of draining lymph vessels in 163/171 cases (95.3%). In 6/171 cases (3.5%) in-bore needle retraction lead to lymphatic enhancement. In one patient [2/171 nodes (1.1%)] no lymphatic enhancement was seen despite repeated needle repositioning. Overall contrast application was technically successful in 169/171 cases (98.8%). In the 6 groins in which no nodes were identifiable, transpedal MRL was successful. So overall 91/92 MRLs (98.9%) were clinically successful. No complications were recorded. Confirmation of the needle position for nodal MRL by sonographically controlled saline injection is a reliable technique with a high success rate of MRL.

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