Hye Jung Park1, Jung-Won Park2, Min-Suk Yang3, Mi-Yeong Kim4, Sae-Hoon Kim5, Gwang Cheon Jang6, Young-Hee Nam7, Gun-Woo Kim8, Sujeong Kim9, Hye-Kyung Park10, Jae-Woo Jung11, Jong-Sook Park12, Hye-Ryun Kang13. 1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 2. Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 3. Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea. 4. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. 5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 6. Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Korea. 7. Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea. 8. Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea. 9. Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea. 10. Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. 11. Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea. 12. Soonchunhyang University Bucheon Hospital, Bucheon, 420-767, Korea. 13. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. helenmed@snu.ac.kr.
Abstract
OBJECTIVES: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). METHODS: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. RESULTS: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. CONCLUSION: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. KEY POINTS: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.
OBJECTIVES: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). METHODS: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. RESULTS: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. CONCLUSION: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. KEY POINTS: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.
Entities:
Keywords:
Contrast media; Drug hypersensitivity; Hypersensitivity, Immediate; Premedication; Secondary prevention
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