Prophylaxis against fluorescein-induced anaphylactoid reactions

Rohr, Albert S.; Pappano, Joseph E.

doi:10.1016/s0091-6749(05)80022-3

Cited by 15 publications

(6 citation statements)

References 3 publications

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“…We must not neglect the safety issue; common practice of prophylaxis with antihistamines and corticosteroids does not refer to IgE-mediated reactions but only to those of anaphylactoid type. 23 Conclusively, adverse reactions to i.v. SF are rare, but underlying immunologic mechanisms and especially IgE-mediated anaphylaxis are in some cases well documented.…”

Section: Discussionmentioning

confidence: 99%

Skin testing and adverse reactions in fluorescein: A prospective study

Kalogeromitros

Makris²,

Rouvas³

et al. 2007

allergy asthma proc

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Sodium fluorescein (SF) is widely used to assess chorioretinal disorders. Adverse reactions are well documented but the underlying mechanism is still uncertain. The aim of this study was the evaluation of skin testing to predict SF reaction, the identification of possible predisposing factors, and the objective record of the reported reactions. All patients with adequate indication for SF angiography (SFA) during an 18-month period were evaluated as follows: (a) detailed personal history of atopy, diabetes, previous SFA, and/or diagnostic procedures with radiocontrast media (RCM) and possible side effect; (b) skin testing with SF 10% diluted preparations; (c) SFA with 5 mL of SF, objective record of any reaction. Two hundred twenty-four patients (108 men and 116 women) with a mean age of 65.2 years (SD, 12.86; range, 16-92 years) underwent SFA. The overall rate of adverse reactions was 3.6% (8/224), which consists of 5 (2.2%) individuals with transient mild nausea; 2 (0.9%) subjects with face and upper trunk flushing that appeared in one case after 60 minutes and in the other case 24 hours later and both resolved without treatment, and I subject with transient bilateral frontal headache and dizziness. None of the 224 patients had positive skin or intradermal testings. One hundred thirty-six of 224 (60.7%) patients stated no previous SFA and 74.1% had not performed RCM injection. None of the recorded variables correlated with increased risk of reaction. SFA is a safe procedure with minor adverse effects. Although in vivo testing can not identify reactors it may help to exclude an underlying IgE-mediated mechanism in susceptible individuals.

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Section: Discussionmentioning

confidence: 99%

Skin testing and adverse reactions in fluorescein: A prospective study

Kalogeromitros

Makris²,

Rouvas³

et al. 2007

allergy asthma proc

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“… 2 Antihistamine, as the main and often only prophylaxis, was considered in patients previously exhibiting urticaria or other symptoms of allergic reactions 2,3 . Other studies have suggested the use of steroid in combination with antihistamine 46 . As the number of patients in these studies is small; the best regimen remains to be determined by larger controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Other studies have suggested the use of steroid in combination with antihistamine. 46 As the number of patients in these studies is small; the best regimen remains to be determined by larger controlled trials.…”

Section: Discussionsmentioning

confidence: 99%

Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience

Kwan

Barry

McAllister

et al. 2006

Clinical Exper Ophthalmology

163

109

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Fluorescein angiography is a relative safe procedure and comparable to other intravenous radiocontrast media angiography or investigation. The present results are consistent with previous studies. Prophylactic treatment, fluorescein desensitization or oral fluorescein angiography should be considered in high-risk patients. Safe guards should be in place to manage potential serious adverse reactions. Other imaging techniques, like optical coherence tomography, should be considered as an alternative in selected cases.

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“…Such reactions can be explained by different pathophysiologic mechanisms; however they are probably of the anaphylactoid type, characterized by independent IgE mechanisms that involve direct activation of mast cells, activation of complement system and alterations in arachidonic acid metabolism (22)(23) . Skin tests with fluorescein have no predictive value and it is useless to perform them since the reaction mechanism is not IgE-mediated, and thus they reinforce the above described pathophysiology (24)(25) . Death as result of the test was not observed in this study, though it may occur very rarely.…”

Section: Discussionmentioning

confidence: 99%