Allergic Reactions in 10,000 Consecutive Intravenous Urographies

Wp, Coleman; Sf, Ochsner; Be, Watson

doi:10.1097/00007611-196412000-00004

Cited by 52 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While these reactions are generally mild in nature, approximately 1% to 3% of patients who receive ionic RCM and 0.05% of patients who receive nonionic RCM have severe reactions and most are immediate. 1,2 Most delayed reactions are mild cutaneous eruptions and rarely anaphylactic. The current management of patients with known RCM hypersensitivity who require RCM studies involves using nonionic and iso-osmolar RCM and premedication with antihistamine and systemic corticosteroids.…”

mentioning

confidence: 99%

Successful Graded Dose Challenge to Iodixanol Radiocontrast Media in a Patient With Delayed Anaphylaxis to Iohexol

Soffer

Cohen

Toh

et al. 2017

Vasc Endovascular Surg

View full text Add to dashboard Cite

We present a case of an 82-year-old male with known radiocontrast media (RCM) hypersensitivity who was admitted to our hospital with gangrene of his right toe. The plan for revascularization of his lower extremity required an angiogram. This presented a management challenge as the patient had experienced 2 episodes of delayed anaphylaxis to Omnipaque (iohexol) RCM, and based on a literature review, there was no known or established precedent on a safe procedure in these situations. The patient was premedicated and given a graded dose challenge of an alternative RCM (iodixanol) prior to the radiographic study. He was given 1% of the total expected dose 1 hour before to the procedure and an additional 10% for the 30 minutes prior. He was then given the final dose in the operating room. Following angiogram, the patient was monitored for 18 hours in the postanesthesia care unit, with no adverse reactions. He was placed on a prednisone taper for 1 week, with daily diphenhydramine. The patient remained asymptomatic throughout the hospital course. This novel approach to RCM hypersensitivity management lends itself to a hope that graded dose challenges may play a greater role in the management of these patients.

show abstract

mentioning

confidence: 99%

Successful Graded Dose Challenge to Iodixanol Radiocontrast Media in a Patient With Delayed Anaphylaxis to Iohexol

Soffer

Cohen

Toh

et al. 2017

Vasc Endovascular Surg

View full text Add to dashboard Cite

show abstract

“…The infusion of ionic radiographic contrast media (RCM) is connected with a certain risk of adverse reactions which occur at a frequency of 5-15% [2,5,26,27,31]. Lethal reactions are estimated to occur with a frequency of 1:10,000-1:40,000 [26,31].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Anaphylactoid Reactions after Radiographic Contrast Media Infusion by Combined Histamine H<sub>1</sub>- and H<sub>2</sub>-Receptor Antagonists: Results of a Prospective Controlled Trial

Ring

Rothenberger

Clauß³

1985

Int Arch Allergy Immunol

View full text Add to dashboard Cite

In a prospective randomized trial, 800 patients undergoing intravenous urography were pretreated with either intravenous prednisolone (group I), the H₁-antagonist clemastin (group II), a combination of clemastin and the H₁-antagonist cimetidine (group III) or 0.9% saline (group IV). There was an overall incidence of 18–19% side reactions, when subjective and objective symptoms were regarded together. There was no significant difference between the four groups in the total incidence. The same applies when considering subjective side effects including the symptom ‘heat sensation’ that occurred in 10–12% of all patients. However, when side effects excluding the symptom ‘heat sensation’ were regarded and the individual groups were compared, there was a significant difference in frequency between the control group (12%) and the combined H₁/H₂ group (6%). Prednisolone and clemastin did not produce a significant reduction of side effects. The combined application of histamine H₁- and H₂-antagonists might be useful in prophylaxis of radiographic contrast media-induced adverse reactions.

show abstract