Systemic anaphylactoid reactions to lodinated contrast media during cardiac catheterization procedures: Guidelines for prevention, diagnosis, and treatment

Goss, Jerome E.; Chambers, Charles E.; Heupler, Frederick A.

doi:10.1002/ccd.1810340403

Cited by 70 publications

(33 citation statements)

References 18 publications

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“…1) Adverse reactions related to nonionic contrast media are estimated at 5-10%. 2,3) These incidence rates are consistent with available data on adverse reactions for non-invasive radiologic procedures. 4) Renal injury from contrast media is widely established and there are a few proposed risk models to predict the risk of renal injury.…”

Section: Discussionsupporting

confidence: 84%

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

2018

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SummaryAllergic reactions to contrast media are a frequently reported complication of coronary angiography. The majority of patients experience mild, self-limited episodes, but in rare cases patients may experience severe, persistent symptoms. A strategy of premedication with corticosteroids and anti-histamines and an optimal selection of contrast agent is almost always successful in averting contrast reactions, yet a select few patients will continue to have breakthrough events. This is a case of recurrent, severe allergy to contrast media despite standard precautions complicating the treatment of non-ST elevation myocardial infarction (NSTEMI). Our patient was successfully managed with a strategy of rapid desensitization to iodinated contrast media achieved by administering progressively incremental doses of the media.(Int Heart J Advance Publication) Key words: Coronary artery disease, Chemotoxic reaction, Anaphylactoid reaction M inor allergic reactions to contrast media are a frequently reported complication of coronary angiography though severe allergic reactions are much less common. Such events are typically prevented with premedication and selection of appropriate contrast media prior to the procedure. Here we present a case of refractory, severe allergic reaction to contrast media during coronary angiography that was successfully managed with a desensitization protocol. Case ReportThe patient was a 67-year-old man with a history of non-obstructive coronary artery disease (CAD) diagnosed 3 years previously on a coronary angiogram that demonstrated a 50% stenosis in the mid left anterior descending artery (LAD), pacemaker placement for complete heart block (CHB), asthma and bladder cancer who was initially admitted to our affiliated Veterans Hospital for a planned cystoscopy/retrograde pyelogram. While in recovery in the post-anesthesia care unit he informed his nurse of intra-operative chest pain that had since resolved. An electrocardiogram (ECG) was unchanged from baseline. His first troponin was 0.18. He was started on dual antiplatelet therapy and anticoagulation and continued on his beta-blocker and statin. His troponin peaked at 0.20 the following day. Urgent revascularization for NSTEMI was scheduled for the following morning.Pre-catheterization evaluation revealed a significant history of allergic reaction to contrast media. In early 2013 the patient developed nausea and an erythematous, pruritic rash following a contrast-enhanced CT scan of the abdomen and pelvis. A contrast allergy was added to his medical record. He was scheduled for coronary angiography later that year, and was pretreated with oral prednisone 50 mg (13 hours, 7 hours and 1 hour pre-procedure), as well as oral diphenhydramine (1 hour pre-procedure). Despite pretreatment he developed severe nausea and pruritus, with scattered erythema and bullae noted on exam. He was treated with intravenous methylprednisolone, famotidine, and diphenhydramine, and monitored in the ICU for 2 days. He was hospitalized again in 2014 after develop...

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Section: Discussionsupporting

confidence: 84%

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

2018

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“…As stated at the outset, there is scanty evidence relating specifically to management of iron infusions: the recommendations made below are drawn from other contexts in which IV drugs are given. 17,[27][28][29][30][31] The selection of individual drugs for treatment of HSRs and their doses and routes of administration vary and can be modified according to local practice.…”

Section: How Should Hypersensitivity Reactions To Intravenous Iron Bementioning

confidence: 99%

“…30 Their therapeutic benefit is unclear, and indeed, by sometimes potentiating tachycardia, hypotension and somnolence, H1 antagonists can make an HSR appear more hemodynamically significant.…”

Section: How Should Hypersensitivity Reactions To Intravenous Iron Bementioning

confidence: 99%

Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management

Rampton¹,

Folkersen²,

Fishbane³

et al. 2014

Haematologica

256

251

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“…Goss et al in 1995 reported incidence of contrast related severe anaphylactic reaction to be 0.23% in Cathlab during cardiac catheterisation. 19 Contrast induced nephropathy (CIN) is an iatrogenic renal injury that follows intravascular administration of radio-opaque contrast media. Expectedly more and more patients are at risk of developing CIN with advancement of radioimaging diagnostic and therapeutic modalities and its ever-increasing use.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile of patients undergoing coronary angiography with special reference to complications of coronary angiography

et al. 2017

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Background: Cardiovascular Diseases (CVD’s) remain the biggest cause of death worldwide. Recent trends suggest that disease incidence has escalated and has started affecting younger age group also. Incidence of CVD’s has been on increasing trend not only in urban areas but in rural areas also. Aim of this research is to study clinical profile and complications in patients undergoing coronary angiography.Methods: 100 patients admitted in hospital who were planned for coronary angiography were selected. All routine investigations, Hba1c if patient is known diabetic, Serology, ECG, CXR were done at the time of admission. General physical and local examinations were performed at the end of procedure, after 12, 48 and 72 hours of coronary angiography.Results: Acute Myocardial Infarction (AMI) is the commonest indication for CAG in this study group. Out of 100 patients who underwent CAG, complications occurred in 29 individuals. Only 3 types of complications- Haematoma, Anaphylactoid reactions and Contrast Induced Nephropathy (CIN) are observed in this study.Conclusions: Hypertension, obesity, family history of IHD in first degree relatives and DM are important risk factors for IHD. Most common complication of CAG is haematoma. Females patients are more predisposed for all complications DM, HTN, advanced age and CHF are independent risk factors for developing CIN.

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Systemic anaphylactoid reactions to lodinated contrast media during cardiac catheterization procedures: Guidelines for prevention, diagnosis, and treatment

Cited by 70 publications

References 18 publications

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management

Clinical profile of patients undergoing coronary angiography with special reference to complications of coronary angiography

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