Risk for Anaphylactic Reaction from Cardiac Catheterization in Patients Receiving β-Adrenergic Blockers or Angiotensin-Converting Enzyme-Inhibitors

The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions

“…71,72 For patients on beta-blockers, recent studies showed that the intake of these medications does not increase the risk of HR to ICM. 73 Clinical trials demonstrate an overall allergic-like reaction rate to low osmolar ICM to be 0.6%. 66,74,75 A recent clinical study conducted in 196,081 patients found the incidence rates of overall HRs and severe HRs to be 0.73% and 0.01%, respectively.…”

“…71,72 For patients on beta-blockers, recent studies showed that the intake of these medications does not increase the risk of HR to ICM. 73…”

Life‐threatening bronchospasm induced by an angiotensin‐converting enzyme inhibitor in a chronically ventilated patient: Diagnostic pitfalls and literature review

“…7 ACEi likely intensify the risk of anaphylactic response to other substances, such as iodine-containing contrast media. 12 The late onset of these adverse reactions and lack of awareness often lead to late recognition of their link to the use of ACEi. For instance, on average, it took 293.2 days to conclude that ACEi administration is responsible for a persistent cough in 446 spontaneous notifications by primary care physicians registered in the French pharmacovigilance database.…”

“…Other features of bradykinin‐mediated reactions are far less common, with angioedema reported in up to 0.7% of patients treated with an ACEi 7 . ACEi likely intensify the risk of anaphylactic response to other substances, such as iodine‐containing contrast media 12 …”

Should we be less reactive about contrast reaction prophylaxis?

“…However, the incidence of contrast reactions has been greatly reduced during the evolution from high osmolar ionic contrast to the current standard of iso‐ or low‐osmolar non‐ionic agents. In fact, a recent publication 2 that evaluated nearly 72,000 cardiac catheterizations found anaphylaxis in only 46 (0.06%), with severe anaphylaxis in only 11 patients (0.015%), and there was no association with the use of beta‐blockers or ACE inhibitors. Unfortunately, there are no randomized trials in the era of nonionic contrast that demonstrate a reduction in anaphylactic reactions.…”