Suh-Young Lee1, Min Suk Yang2, Young-Hoon Choi3, Chang Min Park3, Heung-Woo Park4, Sang Heon Cho5, Hye-Ryun Kang6. 1. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea. 2. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea. 3. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. 5. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea. 6. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea. Electronic address: helenmed@snu.ac.kr.
Abstract
BACKGROUND: Although the severity of hypersensitivity reactions to iodinated contrast media varies, it is well correlated with the severity of recurrent reactions; however, prophylaxis protocols are not severity-stratified. OBJECTIVE: To assess the outcomes of tailored prophylaxis according to the severity of hypersensitivity reactions to iodinated contrast media. METHODS: Our premedication protocols were stratified based on the severity of previous reactions: (1) 4 mg of chlorpheniramine for mild reactions, (2) adding 40 mg of methylprednisolone for moderate reactions, and (3) adding multiple doses of 40 mg of methylprednisolone for severe index reactions. Cases of reexposure in patients with a history of hypersensitivity reactions were routinely monitored and mandatorily recorded. RESULTS: Among a total of 850 patients who underwent enhanced computed tomography after severity-tailored prophylaxis, breakthrough reactions occurred in 17.1%, but most breakthrough reactions (89.0%) were mild and did not require medical treatment. Additional corticosteroid use did not reduce the breakthrough reaction rate in cases with a mild index reaction (16.8% vs 17.2%, P = .70). However, underpremedication with a single dose of corticosteroid revealed significantly higher rates of breakthrough reaction than did double doses of corticosteroid in cases with a severe index reaction (55.6% vs 17.4%, P = .02). Changing the iodinated contrast media resulted in an additional reduction of the breakthrough reaction rate overall (14.9% vs 32.1%, P = .001). CONCLUSION: In a total severity-based stratified prophylaxis regimens and changing iodinated contrast media can be considered in patients with a history of previous hypersensitivity reaction to iodinated contrast media to reduce the risk of breakthrough reactions.
BACKGROUND: Although the severity of hypersensitivity reactions to iodinated contrast media varies, it is well correlated with the severity of recurrent reactions; however, prophylaxis protocols are not severity-stratified. OBJECTIVE: To assess the outcomes of tailored prophylaxis according to the severity of hypersensitivity reactions to iodinated contrast media. METHODS: Our premedication protocols were stratified based on the severity of previous reactions: (1) 4 mg of chlorpheniramine for mild reactions, (2) adding 40 mg of methylprednisolone for moderate reactions, and (3) adding multiple doses of 40 mg of methylprednisolone for severe index reactions. Cases of reexposure in patients with a history of hypersensitivity reactions were routinely monitored and mandatorily recorded. RESULTS: Among a total of 850 patients who underwent enhanced computed tomography after severity-tailored prophylaxis, breakthrough reactions occurred in 17.1%, but most breakthrough reactions (89.0%) were mild and did not require medical treatment. Additional corticosteroid use did not reduce the breakthrough reaction rate in cases with a mild index reaction (16.8% vs 17.2%, P = .70). However, underpremedication with a single dose of corticosteroid revealed significantly higher rates of breakthrough reaction than did double doses of corticosteroid in cases with a severe index reaction (55.6% vs 17.4%, P = .02). Changing the iodinated contrast media resulted in an additional reduction of the breakthrough reaction rate overall (14.9% vs 32.1%, P = .001). CONCLUSION: In a total severity-based stratified prophylaxis regimens and changing iodinated contrast media can be considered in patients with a history of previous hypersensitivity reaction to iodinated contrast media to reduce the risk of breakthrough reactions.
Authors: Yeon Soo Kim; Young Hun Choi; Yeon Jin Cho; Seunghyun Lee; Soon Ho Yoon; Chang Min Park; Hye Ryun Kang Journal: Korean J Radiol Date: 2018-02-22 Impact factor: 3.500
Authors: Patrizia Bonadonna; Knut Brockow; Marek Niedoszytko; Hanneke Oude Elberink; Cem Akin; Boguslaw Nedoszytko; Joseph H Butterfield; Ivan Alvarez-Twose; Karl Sotlar; Juliana Schwaab; Mohamad Jawhar; Mariana Castells; Wolfgang R Sperr; Olivier Hermine; Jason Gotlib; Roberta Zanotti; Andreas Reiter; Sigurd Broesby-Olsen; Carsten Bindslev-Jensen; Lawrence B Schwartz; Hans-Peter Horny; Deepti Radia; Massimo Triggiani; Vito Sabato; Melody C Carter; Frank Siebenhaar; Alberto Orfao; Clive Grattan; Dean D Metcalfe; Michel Arock; Theo Gulen; Karin Hartmann; Peter Valent Journal: J Allergy Clin Immunol Pract Date: 2021-04-05