Acute reactions to intravascular contrast media: types, risk factors, recognition, and specific treatment.

Bush, William H.; Swanson, Dennis P.

doi:10.2214/ajr.157.6.1950858

Cited by 242 publications

(124 citation statements)

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“…This complex combines on the surface of mast cells and basophils stimulating histamine release. Unlike anaphylactic reactions, the exact mechanism of the nonimmunemediated anaphylactoid reaction is not well worked out, but is most likely histamine mediated [ 1,6,7].…”

Section: Pathophysiologymentioning

confidence: 99%

“…1 hr before procedure. This is effective in the reduction of recurrent anaphylactoid reactions to standard contrast agents [ 1,6].…”

Section: Preventionmentioning

confidence: 99%

“…Epinephrine should be cautiously administered to patients treated with beta blocker therapy. If the beta adrenergic effect of epinephrine is blocked, the alpha adrenergic effect will predominate resulting in a hypertensive reaction [ 1,2].…”

Section: Treatmentmentioning

confidence: 99%

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

Goss

Chambers

Heupler

1995

Cathet. Cardiovasc. Diagn.

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This report represents the first guidelines for prevention, diagnosis, and treatment of anaphylactoid reactions to contrast media occurring specifically during cardiac catheterization. The incidence of contrast media complications in the catheterization laboratory is 0.23% with 1 death per 55,000. Anaphylactoid reactions are nonimmune mediated, but histamine release and other mediators produce a clinical presentation indistinguishable from anaphylaxis. In patients with known previous reactions, pretreatment with steroids and diphenhydramine and the use of nonionic contrast media have significantly reduced the potential of recurrent reaction. Minor reactions such as limited urticaria may be watched for progression or treatment with diphenhydramine, whereas more serious reactions such as angioedema or laryngeal edema require airway stability and ephinephrine administration. Shock should be vigorously treated simultaneously with intravenous epinephrine and large volumes of normal saline. If the patient can be stabilized, the study should be completed as histamine, leukotrienes, and other vasoactive products should be relatively depleted.

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Section: Pathophysiologymentioning

confidence: 99%

“…1 hr before procedure. This is effective in the reduction of recurrent anaphylactoid reactions to standard contrast agents [ 1,6].…”

Section: Preventionmentioning

confidence: 99%

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

Goss

Chambers

Heupler

1995

Cathet. Cardiovasc. Diagn.

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“…Introduction lodinated radiographic contrast media (IRCM) have been in routine clinical use for several decades and it is well known that their intra-arterial administration may cause a variety of clinical side effects (Bush & Swanson, 1991).One of the most common of these is a sensation of warmth or even pain attributable to peripheral vasodilatation, which is more pronounced with the older, high osmolality ionic contrast media (e.g. sodium metrizoate), than the newer low osmolality nonionic monomeric contrast media such as iohexol and iopamidol (Almen, 1987).…”

mentioning

confidence: 99%

Ionic mechanisms contributing to the vasorelaxant properties of iodinated contrast media: a comparison of iohexol and iodixanol in the rabbit isolated aorta

Pitman¹,

Karlsson²,

Griffith³

1996

British J Pharmacology

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1 We have used rings of rabbit thoracic aorta to investigate the vasorelaxant properties of two different classes of non-ionic iodinated radiographic contrast media (IRCM) and the mechanisms, underlying their mode of action. lohexol (a triiodinated monomer) was compared with iodixanol (a hexaiodinated dimer).2 lohexol and iodixanol both relaxed phenylephrine (0.3 gM) constricted rabbit aorta in a concentration-dependent manner that did not depend on the presence of an intact endothelium. When expressed as a function of iodine concentration, iodixanol caused significantly less relaxation than iohexol. However, the extent of relaxation was similar for both IRCM when expressed on a molar basis. Furthermore, increasing the molarity of the buffer to comparable levels with mannitol evoked only a small (-15%) relaxation of phenylephrine-induced tone.3 Ouabain (10 gM) significantly inhibited both iohexol-and iodixanol-induced relaxations by -30%.5-(N-Ethyl-N-isopropyl)-amiloride (EIPA, 100 nM) significantly inhibited iohexol-induced relaxation to the same extent as ouabain, but did not alter the vasorelaxant effect of iodixanol. Co-incubation with ouabain and EIPA had an additive effect in the case of iohexol, increasing inhibition of relaxation to -60%, whereas inhibition of iodixanol-induced relaxation by the combination of ouabain plus EIPA did not differ from that of ouabain alone. 4 Replacing NaCl with N-methyl-D-glucamine (NMDG) to lower extracellular [Na+] and thereby inhibit Na+ -Ca2" exchange, attenuated the relaxation evoked by iohexol or by iodixanol (by -25%) in each case. 5 We conclude that iohexol-and iodixanol-induced vasorelaxation in rabbit aorta is mediated through a direct action on vascular smooth muscle that is not simply a consequence of altered osmolality. It involves modulation of the Na+-K+ ATPase and, in the case of iohexol, Na+-H+ exchange. Both agents also appear to modulate Na+ -Ca2+ exchange, through direct and/or indirect mechanisms. This is the first study to show specific pharmacological differences between monomeric and dimeric contrast media in vascular smooth muscle.

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“…Since hyperosmolarity may be responsible for some of the adverse reactions caused by RCM (11,12), new RCM with lower osmolarity have been developed. With the use of these novel preparations, the incidence of overall ad verse reactions was reduced from 12.66% of patients who received higher osmolar RCM to 3.31 %, and the inci dence of severe anaphylactoid reactions (sudden drop in blood pressure, cardiac arrest, loss of consciousness, or dyspnea requiring treatment) was reduced from 0.22% to 0.04% (2).…”

Section: Iodinated Radiographicmentioning

confidence: 99%

Enhancement by Morphine of Radiographic Contrast Media-Induced Histamine Release in Rat Peritoneal Mast Cells.

et al. 1997

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ABSTRACT-The intravascular application of radiographic contrast media causes hypersensitivity reac tions, in which histamine release may play a major role. We examined the interaction between contrast medium and morphine. Among the four nonionic contrast media examined, iopamidol showed the most marked histamine release from rat peritoneal mast cells in vitro. Although iopamidol and morphine them selves did not induce histamine release at concentrations up to 65 mgI/ml and 3 mM, respectively, their combination resulted in a significant histamine release. These findings suggest that patients with exposure to medicines that induce histamine release may have a higher incidence and severity of hypersensitivity reac tions to radiographic contrast media.

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Acute reactions to intravascular contrast media: types, risk factors, recognition, and specific treatment.

Cited by 242 publications

References 0 publications

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

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

Ionic mechanisms contributing to the vasorelaxant properties of iodinated contrast media: a comparison of iohexol and iodixanol in the rabbit isolated aorta

Enhancement by Morphine of Radiographic Contrast Media-Induced Histamine Release in Rat Peritoneal Mast Cells.

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