Anaphylaxis to Iodinated Contrast Media: Clinical Characteristics Related with Development of Anaphylactic Shock

Abstract

ObjectiveAnaphylaxis is the most severe form of radiocontrast media (RCM) induced hypersensitivity and can be life-threatening if profound hypotension is combined. With increased use of iodine based RCM, related hypersensitivity is rapidly growing. However, the clinical characteristics and risk factors of RCM induced anaphylaxis accompanied by hypotension (anaphylactic shock) are not clearly defined. This study was performed to investigate the risk factors of RCM induced anaphylactic shock and the clinical value of RCM skin testing to identify causative agents in affected patients.MethodsWe analyzed the data of RCM induced anaphylaxis monitored by an inhospital pharmacovigilance center at a tertiary teaching hospital from January 2005 to December 2012 and compared the clinical features and skin test results according to the accompanying hypotension.ResultsAmong total of 104 cases of RCM induced anaphylaxis, 34.6% of patients, developed anaphylaxis on their first exposure to RCM. Anaphylactic patients presenting with shock were older (57.4 vs. 50.1 years, p = 0.026) and had a history of more frequently exposure to RCM (5.1±7.8 vs. 1.9±3.3, p = 0.004) compared to those without hypotension. Among RCMs, hypotension was more frequent in anaphylaxis related to iopromide compared to other agents (85.0% vs. 61.4%, p = 0.011). Skin tests were performed in 51 patients after development of RCM induced anaphylaxis. Overall skin test positivity to RCM was 64.7% and 81.8% in patients with anaphylactic shock.ConclusionRCM induced anaphylactic shock is related to multiple exposures to RCM and most patients showed skin test positivity to RCM.

Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis

“…Pooled per‐patient cross‐reactivity rates were 39% (95% CI, 29–50%; I 2 = 9%) in immediate HSR and 68% (95% CI, 48–83%; I 2 = 36%) in nonimmediate HSR (Fig. , and Table S7) .…”

“…Our initial search identified 2020 references. Of these references, 21 studies were finally included in our analysis (Fig. ; Tables S2 and S3).…”

“…The number of the study populations in the included studies ranged from 4 to 122 in immediate HSR and from 10 to 161 in nonimmediate HSR (Table ) . All studies were performed in Europe and Asia.…”

“…The pooled positive rate of SPTs was 3% (95% CI, 1–5%; I 2 = 0%) . The pooled positive rates of IDT were shown to rise as the severity of reactions increased (mild HSR, 12% [95% CI, 6–23%], I 2 = 38% ; moderate HSR, 16% [95% CI, 10–24%], I 2 = 6% ; severe HSR, 52% [95% CI, 31–74%], I 2 = 42% ). Intradermal test positivity in patients with immediate HSR was more frequently found when the culprit ICM was applied (applying culprit ICM, 23% [95% CI, 14–36%], I 2 = 45%; not applying culprit ICM, 3% [95% CI, 1–6%], I 2 = 20% ).…”

Practical Approach to VTE Management in Hospitalized Patients

“…Use of a different type (low or high osmolar) of RCM after negative skin testing may still be associated with a recurrence of anaphylaxis. 67,68 Physicians must be prepared for emergency therapy of a possible recurrent reaction in all patients with past hypersensitivity reactions to RCM.…”