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Systemic Anaphylactoid Reactions to Contrast Media During Cardiac Catheterization Procedures. Diagnosis, Prevention, and Treatment Brandon E. Brown, M.D. Department of Internal Medicine. Clinical Scenario.
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Diagnosis, Prevention, and Treatment
Brandon E. Brown, M.D.
Department of Internal Medicine
Anaphylactoid events vs. Anaphylaxis
Radiocontrast material (RCM)
*Neuget AI. Ghatak AT. Miller RL. Anaphylaxis in the United States: an investigation into its epidemiology. Archives of Internal Medicine. 161(1):15-21, 2001 Jan 8.
The substantial reduction in toxicity with introduction of low-osmolar agents suggests hypertonicity of older agents played a role
In vitro data indicates RCM can activate basophils and mast cells by an IgE-independent mechanism (ie anaphylactoid)
RCM’s have been shown to activate (directly and indirectly) complement, fibrinolytic, and kinin systems
Several factors argue against an immunologic pathogenesis:
*Mita H, Tadokoro K, Akiyama K. Detection of IgE antibody to a radiocontrast medium. Allergy 1998; 53:1133-40.
Who’s at risk?
*Coakley FV, Pannicck DM. Iodine allergy:an oyster without a pearl? Am J Roengenol 1997:169:951-2
*Leder R. How well does a history of seafood allergy predict the likelihood of an adverse reaction to IV contrast material? Am J Roentgenol 1997:906-7.
What can you do to minimize risk?
effective (next slide)
A Pre-treatment Medical regimen*:
*Greenberger PA, Patterson R. The Prevention of Immediate Generalized Reactions to Radiocontrast Media in High-risk Patients. J Allergy Clin Immunol 1991;87:867-872.
*Marshall GD Jr., Lieberman PL. Comparison of three pretreatment protocols to prevent anaphylactoid reactions to radiocontrast media. Annals of Allergy. 67(1):70-4, 1991 Jul.
Depends on severity of reaction and specific clinical manifestation
Minor (erythema, pruritis),Moderate (urticaria, angioedema, bronchospasm), and Severe (shock, respiratory arrest) reactions