Anaphylaxis to radiographic contrast media

Brockow, Knut; Ring, Johannes

doi:10.1097/aci.0b013e32834877c3

Cited by 73 publications

(48 citation statements)

References 36 publications

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“…While these observations do not constitute direct evidence of an IgE-related mechanism, but rather of mast cell activation [14,59], recent studies have also indirectly shown the presence of specific IgE using the basophil activation test [16,17,53].…”

Section: Immediate Reactionsmentioning

confidence: 89%

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Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Rosado¹,

Díaz²,

Moreno³

et al. 2016

J Investig Allergol Clin Immunol

126

124

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The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported. Key words: Iodinated. Gadolinium. Contrast media. Allergy. Hypersensitivity. Anaphylaxis. Immediate reactions. Nonimmediate reactions. PrologueThe objective of these guidelines is to ensure efficient and effective clinical practice in the diagnosis and management of hypersensitivity reactions to radiologic contrast media. The guidelines were developed by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) with extensive clinical expertise in the evaluation and management of hypersensitivity reactions and broad research experience.We performed a systematic and independent review of the literature up to November 2015 and established a consensus of expert opinion. We evaluated the applicability of the guidelines in our daily clinical practice. The guidelines were evaluated and criticized by external reviewers with expertise in the field. MethodThe panel of experts who produced this consensus document developed a research protocol outlining the background to the subject of study, the objectives of the study, and the questions and hypotheses from which search criteria were defined.The main sources used for the literature search included electronic databases and archives (MEDLINE-PubMed, Science Direct, OVID) and a database of systematic re...

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Section: Immediate Reactionsmentioning

confidence: 89%

“…The various mechanisms involved in immediate nonallergic reactions [52] include the following: (1) the direct membrane effect, possibly related to the osmolality of the ICM solution [53]; (2) activation of the complement system [54]; and (3) direct formation of bradykinin [55].…”

Section: Immediate Reactionsmentioning

confidence: 99%

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Rosado¹,

Díaz²,

Moreno³

et al. 2016

J Investig Allergol Clin Immunol

126

124

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“…Patients are exposed to needless radiation, with the attendant risks of radiation-induced cancers, 14 and to contrast administration, with the attendant risks of kidney injury and anaphylactoid reactions. [55][56][57] Patients with a low clinical probability of PE, a negative D-dimer test or both who nonetheless undergo CT pulmonary angiography are more likely to have either an incidental fi nding necessitating further testing 58 or an isolated subsegmental PE of unclear signifi cance 59 identifi ed than a more central PE. Although isolated subsegmental emboli may be clinically insignifi cant, they are typically treated with anticoagulation, exposing patients to the risks of bleed ing.…”

Section: Table 1-ten Proposed Items Explored In Further Detail Inclumentioning

confidence: 99%

An Official American Thoracic Society/American College of Chest Physicians Policy Statement

Wiener

Ouellette

Diamond³

et al. 2014

Chest

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CHEST T he United States spends more per capita on health care than any other developed nation. 1 Although spending more money yields health benefi ts in some contexts, the United States has crossed onto the "fl at of the curve," in which spending more does not improve health. 2 Research on geographic variations in healthcare spending has shown that spending more money, doing more testing, and providing more expensive treatments does not consistently yield better outcomes. 3 In fact, in many cases, overtesting and overtreatment can cause harm, as patients are exposed to radiation from extraneous imaging, physical complications from invasive procedures that are not clearly indicated, and adverse effects from unwarranted medications. 4 Physicians have professional obligations to both their individual patients and to society. 5 As such, it is incumbent upon physicians to help rein in the use of tests and treatments that offer little benefi t, may cause harm, and add considerable expense. The question is, where to begin? It can be diffi cult for busy clinicians to stay up-to-date on the latest evidence on the benefi ts and harms of all tests and treatments in their fi eld, and (1) Do not perform CT scan surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines; (2) do not routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (groups II or III pulmonary hypertension); (3) for patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, do not renew the prescription without assessing the patient for ongoing hypoxemia; (4) do not perform chest CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay; (5) do not perform CT scan screening for lung cancer among patients at low risk for lung cancer. We hope pulmonologists will use these recommendations to stimulate frank discussions with patients about when these tests and treatments are indicated-and when they are not.

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“…Nonmediated reactions to radiocontrast media, occurring >1 h after administration, mainly consist of skin manifestations. Most of these appear to be allergic reactions mediated by T cells, demonstrated by (1) the frequently reported positive patch tests and delayed intradermal tests to the culprit contrast medium in previous reactors, (2) the presence of dermal infiltrates of T cells in the affected skin areas, (3) the reappearance of the eruption after provocation testing, and (4) the ability of the contrast medium to stimulate the proliferation of peripheral T cells from patients with contrast medium-induced skin eruptions [8,9,10,13,16,17,18,19,20]. …”

Section: Discussionmentioning

confidence: 99%

“…Iodinated radiocontrast media, contrast agents used in magnetic resonance (MR) imaging, microbubbles used as ultrasound contrast agents, blue dyes used to map sentinel nodes during the staging procedures of cancer and other malignancies as well as contrast compounds used in neurosurgery and ophthalmic surgery are all capable of inducing adverse reactions that can be allergic or nonallergic, immediate or delayed [7,8,9]. Severe reactions reported in the literature mainly result from venous and arterial injection, though rare cases have been observed following other routes of administration due to the absorption of the medium into the circulation [10,11].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors in Fatal Cases of Anaphylaxis due to Contrast Media: A Forensic Evaluation

Palmière

Bonetti

2014

Int Arch Allergy Immunol

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Background: Fatalities following contrast medium exposure are extremely rare in clinical routine, though they may occur as an exception. Some may fall under the purview of the inquiring authorities and forensic pathologists due to their in-hospital occurrence. The purpose of this study was to assess the risk factors for anaphylaxis due to contrast medium administration that can be identified in fatal cases. Methods: Fatalities occurred during the course of clinical investigations with contrast media described in the literature and fatal reactions to contrast agents that had undergone forensic investigations in our medicolegal center were reviewed with respect to patient characteristics, administered contrast medium, performed biochemical investigations and potential risk factors identified based on clinical history and medical records. Results: Biochemical investigations into the fatal cases examined in our facility revealed increased mast cell tryptase, total IgE and activated mast cells in all subjects. Data obtained from the literature and our own investigations indicated that in only a minority of the fatal cases had there been previous exposure to contrast compounds, while most cases of severe anaphylaxis involved patients who apparently reacted on initial exposure. Conclusions: Most fatal cases failed to present any identifiable predisposing conditions out of those traditionally considered as risk factors for an anaphylactic reaction to contrast compounds in the medical histories of the patients. Comprehensive clinical histories and thorough reviews of medical data, along with exhaustive forensic investigations, provide information that is relevant in order to better appreciate the interwoven relationships linking all factors potentially involved in the pathogenesis of fatal anaphylaxis to contrast media.

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Anaphylaxis to radiographic contrast media

Cited by 73 publications

References 36 publications

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

An Official American Thoracic Society/American College of Chest Physicians Policy Statement

Risk Factors in Fatal Cases of Anaphylaxis due to Contrast Media: A Forensic Evaluation

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