Kyoung-Hee Sohn1,2, Gun-Woo Kim2,3, Suh-Young Lee2,4,5, Hyo-Soo Kim6, Sang-Heon Cho2,4,5, Jung-Kyu Han7, Hye-Ryun Kang8,9,10. 1. Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea. 2. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea. 3. Department of Internal Medicine, St. Carollo General Hospital, Suncheon, South Korea. 4. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea. 5. Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, South Korea. 6. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea. 7. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea. hpcrates@gmail.com. 8. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea. helenmed@snu.ac.kr. 9. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea. helenmed@snu.ac.kr. 10. Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, South Korea. helenmed@snu.ac.kr.
Abstract
OBJECTIVES: While hypersensitivity reactions (HSR) to intravenously administered iodinated contrast media (ICM) have been well studied, not much is known about HSR to intra-arterially administered ICM. METHODS: A prospective observational study was performed to evaluate coronary angiography (CAG)-induced ICM hypersensitivity in patients who underwent CAG using ICM including ioversol, a low-osmolar non-ionic monomer, and iodixanol, an iso-osmolar non-ionic dimer. The HSR were investigated through in-patient monitoring after CAG and telephone interview after discharge. RESULTS: A total of 714 patients were enrolled during the observation period, of whom 26 (3.6%) showed immediate HSR and 108 (15.1%) showed delayed HSR. With regard to severity, proportion of immediate HSR grades 1, 2, and 3 was 57.7%, 38.5%, and 3.8%, respectively, whereas that of delayed HSR grades 1, 2, and 3 was 85.2%, 13.9%, and 0.9%, respectively. Multivariate analysis revealed that previous intra-arterial exposure to ICM was an independent risk factor for immediate HSR (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.22-6.96; p = 0.015). Iodixanol was a significant risk factor for delayed HSR (OR 1.61, 95% CI 1.07-2.43; p = 0.024) and correlated with a higher incidence of delayed HSR within 24-h post-ICM administration compared to ioversol. CONCLUSION: The incidence rate of immediate and delayed HSR in intra-arterially administered ICM was 3.6% and 15.1%, respectively. Previous exposure to intra-arterially administered contrast media was a significant risk factor for immediate HSR. Compared to ioversol, iodixanol was associated with relatively earlier and more frequent delayed HSR. KEY POINTS: • In this prospective study, the incidence of immediate and delayed hypersensitivity in intra-arterial injection of contrast media during coronary angiography was 3.6% and 15.1%, respectively. • Delayed hypersensitivity reactions were more common but less severe than immediate hypersensitivity reactions during coronary angiography. • Previous exposure to ICM via intra-arterial route was a significant risk factor for immediate hypersensitivity to intra-arterial contrast medium.
OBJECTIVES: While hypersensitivity reactions (HSR) to intravenously administered iodinated contrast media (ICM) have been well studied, not much is known about HSR to intra-arterially administered ICM. METHODS: A prospective observational study was performed to evaluate coronary angiography (CAG)-induced ICM hypersensitivity inpatients who underwent CAG using ICM including ioversol, a low-osmolar non-ionic monomer, and iodixanol, an iso-osmolar non-ionic dimer. The HSR were investigated through in-patient monitoring after CAG and telephone interview after discharge. RESULTS: A total of 714 patients were enrolled during the observation period, of whom 26 (3.6%) showed immediate HSR and 108 (15.1%) showed delayed HSR. With regard to severity, proportion of immediate HSR grades 1, 2, and 3 was 57.7%, 38.5%, and 3.8%, respectively, whereas that of delayed HSR grades 1, 2, and 3 was 85.2%, 13.9%, and 0.9%, respectively. Multivariate analysis revealed that previous intra-arterial exposure to ICM was an independent risk factor for immediate HSR (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.22-6.96; p = 0.015). Iodixanol was a significant risk factor for delayed HSR (OR 1.61, 95% CI 1.07-2.43; p = 0.024) and correlated with a higher incidence of delayed HSR within 24-h post-ICM administration compared to ioversol. CONCLUSION: The incidence rate of immediate and delayed HSR in intra-arterially administered ICM was 3.6% and 15.1%, respectively. Previous exposure to intra-arterially administered contrast media was a significant risk factor for immediate HSR. Compared to ioversol, iodixanol was associated with relatively earlier and more frequent delayed HSR. KEY POINTS: • In this prospective study, the incidence of immediate and delayed hypersensitivity in intra-arterial injection of contrast media during coronary angiography was 3.6% and 15.1%, respectively. • Delayed hypersensitivity reactions were more common but less severe than immediate hypersensitivity reactions during coronary angiography. • Previous exposure to ICM via intra-arterial route was a significant risk factor for immediate hypersensitivity to intra-arterial contrast medium.
Authors: Bernard Yu-Hor Thong; Michaela Lucas; Hye-Ryun Kang; Yoon-Seok Chang; Philip Hei Li; Min Moon Tang; James Yun; Jie Shen Fok; Byung-Keun Kim; Mizuho Nagao; Iris Rengganis; Yi-Giien Tsai; Wen-Hung Chung; Masao Yamaguchi; Ticha Rerkpattanapipat; Wasu Kamchaisatian; Ting Fan Leung; Ho Joo Yoon; Luo Zhang; Amir Hamzah Abdul Latiff; Takao Fujisawa; Francis Thien; Mariana C Castells; Pascal Demoly; Jiu-Yao Wang; Ruby Pawankar Journal: Asia Pac Allergy Date: 2020-01-30
Authors: Jung-Hyun Kim; Sang Il Choi; Yoon Jin Lee; Byung-Keun Kim; Heung-Woo Park; Sang-Heon Cho; Yoon-Seok Chang; Sae-Hoon Kim Journal: World Allergy Organ J Date: 2021-07-01 Impact factor: 4.084