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To the Editor.—The article by H. Preston Holley, Jr, MD, and Mohamed S. Al-Ibrahim, MD (242:2432, 1979), reported on a patient having CSF eosinophilia following myelography. In the report the authors suggest that "foreign material in the spinal canal can, on occasion, evoke an eosinophilic response by some unknown mechanism."I suggest that eosinophil chemotactic factor (ECF-A) could be responsible for the eosinophilia. This potent mediator is preformed in basophil and mast cell granules and can be released by several mechanisms.1 Iophendylate (Pantopaque) injection, like other contrast media, can act directly on basophils and mast cells, causing mediator release.2Second, contrast media can activate the complement sequence,3 producing C3a and C5a. These anaphylotoxins cause the release of mediators of inflammation,4 which includes ECF-A.Finally, an iophendylate injection can rarely cause a type I (IgE mediated) Gell-and-Coombs hypersensitivity reaction5 that can be associated with the |
