Recurrent immediate hypersensitivity reaction to radiocontrast media despite premedication found to be IgE-mediated
| Autor: | Sherwin Hariri, Thomas Yusin, Alex Wonnaparhown, Tarah Talakoub, Joseph S. Yusin |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Hypersensitivity
Immediate Pulmonary and Respiratory Medicine Allergy medicine.medical_specialty Erythema Premedication medicine.medical_treatment Immunology Contrast Media 030218 nuclear medicine & medical imaging Drug Hypersensitivity 03 medical and health sciences 0302 clinical medicine Humans Immunology and Allergy Medicine Skin Tests Asthma Desensitization (medicine) Angioedema business.industry Immunoglobulin E medicine.disease Dermatology Hypersensitivity reaction Regimen 030228 respiratory system Radiopharmaceuticals medicine.symptom business |
| Zdroj: | Annals of Allergy, Asthma & Immunology. 124:296-298 |
| ISSN: | 1081-1206 |
| DOI: | 10.1016/j.anai.2019.12.030 |
| Popis: | Introduction The majority of radiocontrast media (RCM) reactions are from direct mast cell degeneration,[1] but there are some patients with recurrent reactions despite standard premedication who may have immediate hypersensitivity reactions[1] (IHR). Although some have found skin testing a helpful tool,[2] consensus on the best method of diagnosis and treatment is lacking. Case Description The patient is a 73-year-old Caucasian female with history of angioedema and urticaria after RCM administration on three separate occasions, despite premedication[3] with the last two exposures, history of asthma, and bicuspid aortic valve status post replacement in 2016. She presented with dyspnea and chest discomfort, diagnosed with severe prosthetic stenosis, and TAVR was recommended. Due to need for cardiac intervention with RCM, the patient underwent skin prick testing followed by intradermal testing with Iodixanol, resulting positive. Therefore, an IgE-mediated IHR to contrast dye was deduced and the patient received a desensitization protocol[4] in addition to a stronger premedication regimen[4] prior to her cardiac intervention. This was successful in preventing angioedema or urticaria, with only mild pruritus and erythema on her extremities, which resolved within 24 hours. Discussion With at least seventy million patients exposed to RCM yearly,[5] Allergist face a growing need for an efficient IHR evaluation protocol. Risk factors for recurrent reaction currently include prior severe allergic reaction to any substance, drug allergies, chronic oral glucocorticoid use, and allergy to four or more allergens.[6] Without all variables for IHR in RCM known, there remains much ambiguity in evaluation strategy, with further research required. |
| Databáze: | OpenAIRE |
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