Elevated Risk of Anaphylactoid Reaction From Radiographic Contrast Media Is Associated With Both ß-Blocker Exposure and Cardiovascular Disorders

Lang, David M.; Alpern, Mathew; Visintainer, Paul; Smith, Stephen T.

doi:10.1001/archinte.1993.00410170119012

Cited by 91 publications

(10 citation statements)

References 44 publications

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“…Other risk factors for more severe immediate reactions are severe allergy, bronchial asthma, cardiac disease and treatment with beta‐blockers (4, 22, 25–27).…”

Section: Risk Factorsmentioning

confidence: 99%

Management of hypersensitivity reactions to iodinated contrast media

Brockow

Christiansen²,

Kanny³

et al. 2005

Allergy

256

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All iodinated contrast media (CM) are known to cause both immediate (≤1 h) and nonimmediate (>1 h) hypersensitivity reactions. Although for most immediate reactions an allergic hypersensitivity cannot be demonstrated, recent studies indicate that the severe immediate reactions may be IgE‐mediated, while most of the nonimmediate exanthematous skin reactions, appear to be T‐cell mediated. Patients who experience such hypersensitivity reactions are therefore advised to undergo an allergologic evaluation. Several investigators have found skin testing to be useful in confirming a CM allergy, especially in patients with nonimmediate skin eruptions. If a patient with confirmed allergy to a CM needs a new CM exposure, a skin test negative CM should be chosen and premedication may be tried. However, none of these precautional measures is a guarantee against a repeat reaction. More research focusing on pathomechanisms, diagnostic testing and premedication is therefore clearly needed in order to prevent CM‐induced hypersensitivity reactions in the future.

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“…Other risk factors for more severe immediate reactions are severe allergy, bronchial asthma, cardiac disease and treatment with beta‐blockers (4, 22, 25–27).…”

Section: Risk Factorsmentioning

confidence: 99%

Management of hypersensitivity reactions to iodinated contrast media

Brockow

Christiansen²,

Kanny³

et al. 2005

Allergy

256

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“…procedures) [58], the risk of major and life-threatening reaction to CM was significantly associated with the presence of cardiovascular disorders [defined on the basis of the medical record information documenting: (i) the pharmacological treatment and (ii) diagnosis of angina, arrhythmia, cardiomyopathy, congestive heart failure, pulmonary hypertension, past myocardial infarction, valvular heart disease, or hypertension]. procedures) [58], the risk of major and life-threatening reaction to CM was significantly associated with the presence of cardiovascular disorders [defined on the basis of the medical record information documenting: (i) the pharmacological treatment and (ii) diagnosis of angina, arrhythmia, cardiomyopathy, congestive heart failure, pulmonary hypertension, past myocardial infarction, valvular heart disease, or hypertension].…”

Section: Cardiac Historymentioning

confidence: 99%

“…The risk of bronchospasm has been shown to be associated with concomitant treatment by b-blocker and with asthma [58]. It may be proposed that b 2 -adrenergic blockade could exacerbate bronchospasm in asthmatic patients.…”

Section: Concomitant Treatment By B-blockersmentioning

confidence: 99%

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Idée

Pinès

Prigent

et al. 2005

Fundamemntal Clinical Pharma

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Allergy-like reactions may occur following administration of iodinated contrast media (CM), mostly in at-risk patients (patients with history of previous reaction, history of allergy, co-treated with interleukin-2 or beta-blockers, etc.) but remain generally unpredictable. Severe and fatal reactions are very rare events. All categories of CM may induce such reactions, although first generation (high osmolar CM) have been found to induce a higher rate of adverse events than low osmolar CM. However, no differences were found between the two categories of CM with respect to mortality. Delayed reactions can also occur. There are no differences between the various categories of CM except for non-ionic dimers, which are more likely to induce such effect. Numerous clinical studies have evaluated the prophylactic value of drugs (mostly antihistamines and corticosteroids). Results are unclear and highly variable. Any prevention depends upon the mechanism involved. However, the mechanism of CM-induced allergy-like reaction remains disputed. Relatively recent data revived the hypothesis of a type-I hypersensitivity mechanism. Positive skin tests to CM have been reported. However, the affinity of IgE towards CM has been found to be very low in the only study which actually evaluated it. Other pathophysiological mechanisms (involving direct secretory effects on mast cells or basophils, or activation of the complement system associated or not with the plasma contact system) are also much debated. Anaphylaxis and anaphylactoid reactions are, in the end, clinically undistinguishable.

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“…Other risk factors for IHR are asthma, use of beta-blockers, old age and cardiovascular diseases. 4,8,41,[43][44][45][46] Reported predisposing factors for NIHR are previous CM-induced hypersensitivity reactions, atopy, interleukin-2 treatment, serum creatinine level >2 mg/dL and a history of drug and contact allergy. 8,47,48 Data on hypersensitivity reactions, skin tests and provocation tests for gadolinium-based contrast media were scarce; however they showed a similar pattern to the hypersensitivity reactions in ICM.…”

Section: Discussionmentioning

confidence: 99%

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

Bansie

Karim

Maaren

et al. 2021

Int J Immunopathol Pharmacol

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Introduction: Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. Methods: A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. Results: Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. Conclusion: In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

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Elevated Risk of Anaphylactoid Reaction From Radiographic Contrast Media Is Associated With Both ß-Blocker Exposure and Cardiovascular Disorders

Cited by 91 publications

References 44 publications

Management of hypersensitivity reactions to iodinated contrast media

Management of hypersensitivity reactions to iodinated contrast media

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

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