LTHOUGH allergic reactions to barium sulfate suspensions are estimated to occur at a rate of less than 2 per million, 1,2 the frequency has been reported to be increasing. 3,4 The cause of these reactions is not known, 5-9 but the additives in barium suspensions, 10-13 medications such as glucagon, 3 and exposure to latex 14-17 -for example, through contact with rubber gloves or balloons -have all been implicated.We describe a patient with anaphylaxis induced by the carboxymethylcellulose sodium in barium sulfate suspension. The reaction occurred after an upper gastrointestinal examination.
CASE REPORTA 63-year-old woman was admitted to the hospital in May 1994 because of an anaphylactic reaction after a double-contrast upper gastrointestinal examination. Before the examination, she had no abdominal discomfort. She had no history of atopic dermatitis, allergic rhinitis, or asthma and had not had any side effects from earlier barium studies. The examination was performed with a 100 percent (wt/vol) suspension of barium sulfate (Balgin S Solution number 3, Kaigen, Osaka, Japan) and gas-producing granules (Kaigen). No other medications were given. The examination revealed no gastritis or peptic ulcers. About 30 minutes later, the patient reported generalized pruritus and urticarial lesions on her abdomen, arms, and face, as well as mild periorbital edema. Within minutes she lost consciousness briefly and had tonic convulsions.On admission, a complete blood count, blood chemical values, and serologic tests were normal. Chest radiographs revealed no abnormalities. The white-cell count was 6400 per cubic millimeter, with 0.5 percent eosinophils. The patient again had transient loss of consciousness and hypotension. She was resuscitated with A subcutaneous injections of epinephrine (0.5 mg), intravenous infusion of fluids, and two injections of methylprednisolone sodium succinate (250 mg each). The urticarial lesions disappeared after 24 hours. The patient recovered fully and went home eight days later.
METHODS
Skin TestingAfter obtaining oral informed consent, we studied the patient and three healthy subjects without atopy or allergies. We conducted skin-scratch tests for each of the components of the barium suspension: barium sulfate, carboxymethylcellulose sodium, sodium metaphosphate, sodium benzoate, sodium dehydroacetate, ethyl parahydroxybenzoate, propyl parahydroxybenzoate, glacial acetic acid, saccharin sodium, and flavorings. All substances (purity, more than 98.0 percent) were mixed with petrolatum and liquid paraffin (10 percent wt/wt) and applied to the skin. The response was evaluated 20 minutes later. The patient also underwent skin-scratch testing with barium sulfate suspension that contained 1.2 percent carboxymethylcellulose sodium and with barium suspension free of carboxymethylcellulose. All the components of the suspension as well as the suspension that did not contain carboxymethylcellulose sodium were obtained from Kaigen.
Histamine Release from Isolated LeukocytesPeripheral blood was withdrawn fr...
