Pretreatment with Corticosteroids to Alleviate Reactions to Intravenous Contrast Material

Lasser, Elliott C.; Berry, Charles C.; Talner, Lee B.; Santini, Lewis C.; Lang, Erich K.; Gerber, Frédéric; Stolberg, Harald O.

doi:10.1056/nejm198710013171401

Cited by 368 publications

(65 citation statements)

References 21 publications

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“…This is similar to Cohan et al's findings in their survey of the Society of Uroradiology (U. S.) [19]; however, the value of using corticosteroid prophylaxis remains contentious [20]. Lasser et al in a randomized study of 6763 patients demonstrated that corticosteroid prophylaxis reduces the incidence of all reactions to ionic contrast medium [21]. The data indicating a protective effect of corticosteroid prophylaxis when non-ionic agents are used is less secure.…”

Section: Discussionsupporting

confidence: 75%

Prevention of generalized reactions to contrast media: a consensus report and guidelines

2001

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The aim of this study was to document, using consensus methodology, current practice for prevention of generalized reactions to contrast media, to identify areas where there is disagreement or confusion and to draw up guidelines for reducing the risk of generalized contrast media reactions based on the survey and a review of the literature. A document with 165 questions was mailed to 202 members of the European Society of Urogenital Radiology. The questions covered risk factors and prophylactic measures for generalized contrast media reactions. Sixty-eight members (34%) responded. The majority indicated that a history of moderate and severe reaction(s) to contrast media and asthma are important risk factors. The survey also indicated that patients with risk factors should receive non-ionic contrast media. In patients at high risk of reaction, if the examination is deemed absolutely necessary, a resuscitation team should be available at the time of the procedure. The majority (91%) used corticosteroid prophylaxis given at least 11 h before contrast medium to patients at increased risk of reaction. The frequency of the dosage varied from one to three times. Fifty-five percent also use antihistamine Hl, mainly administered orally and once. Antihistamine H2 and ephedrine are rarely used. All essential drugs are available on the emergency resuscitation trolley. Patients with risk factors are observed up to 30 min by 48% and up to 60 min by 43% of the responders. Prophylactic measures are not taken before extravascular use of contrast media. Prophylactic drugs are given to patients with a history of moderate or severe generalized reaction to contrast media. In patients with asthma, opinion is divided with only half of the responders giving prophylactic drugs. Aspirin, beta-blockers, interleukin-2 and non-steroid anti-inflammatory drugs are not considered risk factors and therefore are not stopped before injection of contrast media. The survey showed some variability in rating of risk factors for generalized contrast medium reactions, and marked variability in the prophylactic measures used. There remain major areas of uncertainty, and there is insufficient data in the literature to guide practice. Some simple guidelines for prophylaxis of generalized contrast medium reactions are proposed.

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Section: Discussionsupporting

confidence: 75%

Prevention of generalized reactions to contrast media: a consensus report and guidelines

2001

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“…The prophylactic use of corticosteroids in patients at high risk of acute non-renal adverse reactions to ICM is contentious, having been recommended by some authors [2,7,17,18,19] and rejected by others [20,21]. A study conducted by Lasser et al [17] found that two doses of corticosteroid prophylaxis (32 mg methylprednisolone given orally 12 h and 2 h before contrast administration) offered a significant reduction in the incidence of all reactions to high-osmolality contrast media.…”

Section: Preventionmentioning

confidence: 99%

“…A study conducted by Lasser et al [17] found that two doses of corticosteroid prophylaxis (32 mg methylprednisolone given orally 12 h and 2 h before contrast administration) offered a significant reduction in the incidence of all reactions to high-osmolality contrast media. The study also showed that administration of steroids only at the 2 h point before contrast administration did not offer any protective effect [17]. However, in a non-randomised study by Wolf et al [20] the use of non-ionic ICM alone was significantly better in preventing occurrence of all categories of reaction than the use of ionic agents with corticosteroid prophylaxis.…”

Section: Preventionmentioning

confidence: 99%

“…Despite the limited evidence of its efficacy, the prophylaxis regime can be considered in addition to the use of non-ionic media in non-urgent, high-risk patients (those with a history of previous moderate or severe contrast reactions, allergic conditions that require treatment or bronchial asthma) when contrast administration is deemed essential and there is no clinical contraindication to the use of corticosteroids [7,17,18,19]. Brief administration of steroids is relatively safe and inexpensive but should be avoided in patients with diabetes mellitus or active tuberculosis and in the presence of systemic infection [21].…”

Section: Preventionmentioning

confidence: 99%

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Adverse reactions to iodinated contrast media

2001

Eur Radiol

226

126

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Adverse reactions to iodinated contrast media (ICM) are more likely to develop in patients with asthma, a history of allergy or contrast reaction and in those who are debilitated or medically unstable. These reactions can be divided into renal and general, and the latter are subdivided into acute and delayed. Acute general reactions can be minor, intermediate or severe. Fatal reactions are rare. The introduction of low-osmolality agents has caused an overall reduction in the number of non-fatal contrast reactions. Prompt recognition and treatment of acute adverse side effects to ICM is invaluable and may prevent a reaction from becoming severe. Familiarity with cardiopulmonary resuscitation is essential for successful management of life-threatening reactions. Contrast-media-induced renal impairment can be reduced with the use of low-osmolality contrast media and extracellular volume expansion. The use of ICM in diabetic patients receiving metformin should be carried out with care to avoid metformin-induced lactic acidosis. However, this problem is mainly observed in patients with diabetic nephropathy.

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“…All patients received an adapted regimen for preventing allergic reactions to the contrast media; prednisone 100 mg orally was administered before treatment and 50 mg once each on the morning of treatment and the two next days. 13 No other premedications were given routinely. If infusion-related symptoms occurred, the infusion was interrupted and diphenhydramine was administered.…”

Section: Treatment Planmentioning

confidence: 99%

Phase II trial of a 75-mg/m2 dose of docetaxel with prednisone premedication for patients with advanced non-small cell lung cancer

Miller¹,

Rigas²,

Francis³

et al. 1995

Cancer

111

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Background. A prior Phase II study of a 100‐mg/m2 dose of docetaxel conducted at the Memorial Sloan‐Kettering Cancer Center (New York, NY) demonstrated a 38% response rate with grade 3 or 4 neutropenia in 76% of the patients and a grade 2 or greater rash or infusion‐related reaction in 41% and 34% of the patients, respectively. The current Phase II study sought to determine the activity of a 75‐mg/m2 dose of docetaxel to establish whether this lower dose, combined with prednisone, ameliorates toxicity. Methods. Twenty untreated patients with advanced non‐small cell lung cancer (NSCLC) received a 1‐hour 75‐mg/m2 dose of docetaxel every 21 days. Fifty milligrams of prednisone were administered twice the day before chemotherapy and once each of the next 3 days. Patients' disease‐related symptoms were assessed prospectively using the Lung Cancer Symptom Scale (LCSS). Results. All patients were assessable for response and toxicity. Five patients had a major objective response (25%; 95% confidence interval, 11‐50%). The median duration of response was 9.1 months. The projected 1‐year survival was 71%. Grade 3 or 4 neutropenia occurred in 70% of the patients. Grade 2 or greater rash and infusion‐related reactions decreased to 25% each. Analysis of the LCSS measurements found that six of nine component symptoms improved on Day 22, and all improved when baseline measurements were compared with the best value for each patient during the study. Conclusions. Docetaxel administered at a dose of 75 mg/m2 every 21 days shows significant antitumor activity in untreated patients with NSCLC. Neutropenia is comparable with that observed at a 100‐mg/m2 dose. The number of infusional reactions and rash decreased when docetaxel at this dose was administered with prednisone. Based on response rates observed in trials using a 100‐mg/m2 dose with similar degrees of neutropenia, a 100‐mg/m2 dose with steroid pretreatment is recommended future trials. Cancer 1995;75:968‐72.

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Pretreatment with Corticosteroids to Alleviate Reactions to Intravenous Contrast Material

Cited by 368 publications

References 21 publications

Prevention of generalized reactions to contrast media: a consensus report and guidelines

Prevention of generalized reactions to contrast media: a consensus report and guidelines

Adverse reactions to iodinated contrast media

Phase II trial of a 75-mg/m2 dose of docetaxel with prednisone premedication for patients with advanced non-small cell lung cancer

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