Iodinated Contrast Media Allergy in Patients Hospitalized for Investigation of Chest Pain

Topaz, Guy; Karas, Adi; Kassem, Nuha; Kitay-Cohen, Yona; Pereg, David; Shilo, Lotan; Zoref-Lorenz, Adi; Hershko, Alon Y.

doi:10.1016/j.jaip.2018.03.012

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Taken together, these findings and previously published data strongly imply that premedication is administered excessively. 7,8 As the current approach to pre-medication evolved during the era of highosmolality agents, the indications for its administration should be revised. Undue pre-medication entails two potential problems.…”

Section: Discussionmentioning

confidence: 99%

“…6 It was previously shown that in more than a half of the patients who were referred to coronary angiography with a pre-existing diagnosis of allergy, no documentation of a previous response could be obtained. 7,8 Furthermore, one-third of these patients did not receive pre-medication prior to the introduction of ICM, and yet did not develop any adverse responses. This finding highlights the controversy regarding the impact of pre-medication protocols on patient prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…This finding highlights the controversy regarding the impact of pre-medication protocols on patient prognosis. 9 The rate of bona fide allergic reactions to ICM has been reported to be in the range of 0.3e3%, 7,10 whereas severe reactions occur in 0.03e1.6% of injections. 11 Previous studies reported an exceedingly low number of allergic events.…”

Section: Introductionmentioning

confidence: 99%

“…11 Previous studies reported an exceedingly low number of allergic events. 7,8 Of note, the total number of allergic reactions varies among different studies, due to the fact that not all cutaneous manifestations are regarded universally as allergic. 12 Therefore, it was hypothesised that misconceptions regarding reaction severity dictate the actual burden of ICM allergy.…”

Section: Introductionmentioning

confidence: 99%

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Clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media

et al. 2022

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“…Prior retrospective reports of patients undergoing percutaneous coronary interventions using ICM have demonstrated low rates of adverse reactions among patients with or without prior ICM allergy, leading some to advocate for reconsideration of the necessity of premedication with low-ionic ICM. 11 Regardless, current recommendations from the American College of Radiology Manual on Contrast Media in 2020 are premedication regimens consisting of an antihistamine (eg, diphenhydramine) and a steroid (eg, hydrocortisone), with a minimum of 4 hours until contrast exposure for patients with documented ICM allergy. 7 These guidelines were not designed for, nor are they tailored to, address the emergent nature of EVT.…”

Section: Discussionmentioning

confidence: 99%

Emergent Premedication for Contrast Allergy Prior to Endovascular Treatment of Acute Ischemic Stroke

Tonetti

Desai

Morrison

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Management of contrast media allergies may lead to treatment delays in patients with acute ischemic stroke undergoing endovascular therapy. The optimal premedication strategy remains unclear. The aim of this report was to analyze our experience with emergent administration of premedication regimens before endovascular therapy. MATERIALS AND METHODS:We retrospectively reviewed prospective data for all patients undergoing endovascular therapy from 2012 to 2019 at an academic comprehensive stroke center. Records of patients with documented contrast allergy were reviewed and analyzed. Data collected included stroke risk factors and characteristics, historical contrast reaction details, premedication regimens administered, and signs or symptoms of allergic reaction developing post-endovascular therapy. Hospital arrival time to endovascular therapy was compared with that in those who did not have a history of contrast allergy. RESULTS:We analyzed 1521 patients undergoing endovascular therapy; 60 (4%) had documented contrast allergies and constituted the study cohort. The median age was 73 years (interquartile range, 66-81 years), and 65% were women. The median time from premedication to contrast was 24 minutes (interquartile range, 0-36 minutes). Forty-three patients (72%) proceeded directly to endovascular therapy; in 17 patients, the first contrast exposure was CTA. Time from hospital arrival to endovascular therapy was not slower for patients with documented allergies (96 versus 134 minutes, P ¼ .32). No patients experienced a contrast media reaction. CONCLUSIONS:In a single-institution cohort study of 60 consecutive patients with documented contrast allergies undergoing endovascular therapy with emergent premedication en route to (or in) the neuroangiography suite, no patients experienced allergic symptoms. This pragmatic approach may be safe for patients who have documented contrast media allergies. ABBREVIATIONS: EVT ¼ endovascular therapy; ICM ¼ iodinated contrast media; IQR ¼ interquartile range; LVO ¼ large-vessel occlusion A llergic reactions occur in 0.1%-0.6% of patients after exposure

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Absolute zero-contrast percutaneous coronary interventions: An intravascular ultrasound-guided case series and literature review

Sakellariou,

Katsouras,

Papafaklis

et al. 2024

Cardiovascular Revascularization Medicine

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Iodinated Contrast Media Allergy in Patients Hospitalized for Investigation of Chest Pain

Cited by 7 publications

References 21 publications

Clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media

Clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media

Emergent Premedication for Contrast Allergy Prior to Endovascular Treatment of Acute Ischemic Stroke

Absolute zero-contrast percutaneous coronary interventions: An intravascular ultrasound-guided case series and literature review

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