Advertisement

Emergency Pretreatment for Contrast Allergy Before Direct Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Published:September 15, 2008DOI:https://doi.org/10.1016/j.amjcard.2008.07.040
      Patients with previous adverse contrast reactions occasionally present with ST-segment elevation myocardial infarction. Whether they can undergo catheterization safely using current contrast and medications is unknown. We reviewed catheterization laboratory records of all 501 patients (January 2005 to December 2006) presenting with ST-segment elevation myocardial infarction who underwent emergency coronary angiography. Six patients (1.2%) reported a previous contrast reaction including rash, acute bronchospasm, or anaphylaxis. All received a combination of intravenous steroids and H1 and H2 blockers in the emergency department or catheterization laboratory before catheterization. None of these had complications or evidence of allergy in any patient. In conclusion, some patients with previous contrast reaction may undergo emergency catheterization without adverse consequences, although the safety of this approach has not been proved.
      To read this article in full you will need to make a payment

      References

        • Antman E.M.
        • Hand M.
        • Armstrong P.W.
        • Bates E.R.
        • Green L.A.
        • Halasyamani L.K.
        • Hochman J.S.
        • Krumholz H.M.
        • Lamas G.A.
        • Mullany C.J.
        • et al.
        2007 Focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction).
        J Am Coll Cardiol. 2008; 51: 210-247
        • Freed K.S.
        • Leder R.A.
        • Alexander C.
        • DeLong D.M.
        • Kliewer M.A.
        Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication.
        AJR. 2001; 176: 1389-1392
        • Goss J.
        • Chamber C.
        • Heupler F.
        Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis and treatment.
        Catheter Cardiovasc Intervent. 1995; 34: 99-104
        • Mohan J.C.
        • Reddy K.S.
        • Bhatai M.L.
        Anaphylactoid reaction to angiographic contrast media: Recurrence despite pretreatment with corticosteroids.
        Catheter Cardiovasc Intervent. 1984; 10: 465-469
        • Greenberger P.A.
        • Halwig J.M.
        • Patterson R.
        • Wallemark C.B.
        Emergency administration of radiocontrast media in high-risk patients.
        J Allergy Clin Immunol. 1986; 77: 630-634
        • Greenberger P.A.
        • Patterson R.
        • Radin R.C.
        Two pretreatment regimens for high-risk patients receiving radiographic contrast media.
        J Allergy Clin Immunol. 1984; 74: 540-543
        • Lasser E.C.
        • Berry C.C.
        • Tainer L.B.
        • Santini L.C.
        • Lang E.K.
        • Gerber F.H.
        • Stolberg H.O.
        Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material.
        N Engl J Med. 1987; 317: 845-849
        • Wittbrodt E.T.
        • Spinler S.A.
        Prevention of anaphylactoid reactions in high-risk patients receiving radiographic contrast media.
        Ann Pharmacother. 1994; 28: 236-241
        • Katayama H.
        • Yamaguchi K.
        • Kozuka T.
        • Takashima T.
        • Seez P.
        • Matsuura K.
        Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on the Safety of Contrast Media.
        Radiology. 1990; 175: 621-628
        • Lasser E.C.
        • Lyon S.G.
        • Berry C.C.
        Reports on contrast media reactions: analysis of data from reports to the U.S. Food and Drug Administration.
        Radiology. 1997; 203: 605-610
        • Morcos S.K.
        Acute serious and fatal reactions to contrast media: our current understanding.
        Brit J Radiol. 2005; 78: 686-693
        • Wolf G.L.
        • Mishkin M.M.
        • Roux S.G.
        • Halpern E.F.
        • Gottlieb J.
        • Zimmerman J.
        • Gillen J.
        • Thellman C.
        Comparison of the rates of adverse drug reaction: ionic contrast agents, ionic agents combined with steroids, and nonionic agents.
        Invest Radiol. 1991; 26: 404-410
        • Ring J.
        • Rothenberger K.H.
        • Clauss W.
        Prevention of anaphylactoid reactions after radiographic contrast media infusion by combined histamine H1 and H2-receptor antagonists: results of a prospective controlled trial.
        Int Arch Allergy Appl Immunol. 1985; 78: 9-14
        • Siegle R.L.
        • Halvorsen R.A.
        • Dillon H.
        • Gavant M.L.
        • Halpern E.
        The use of iohexol in patients with previous reactions to ionic contrast media.
        Invest Radiol. 1991; 26: 411-416
        • Bush W.H.
        • Swanson D.P.
        Acute reactions to intravascular contrast media: types risk factors, recognition, and specific treatment.
        AJR. 1991; 157: 1153-1161
        • Seymour R.
        • Halpin S.F.
        • Hardman J.A.
        • Coote J.M.
        • Ruttley M.S.T.
        • Roberts G.M.
        Corticosteroid prophylaxis for patients with increased risk of adverse reactions to intravascular contrast agents: a survey of current practice in the UK.
        Clin Radiol. 1994; 49: 791-795
        • Radhakrishnan S.
        • Manoharan S.
        • Fleet M.
        Repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents.
        Clin Radiol. 2005; 60: 58-63
        • Morcos S.K.
        • Thomsen H.S.
        • Webb J.A.W.
        • Contrast Safety Committee of the European Society of Urogenital Radiology
        Prevention of generalized reactions to contrast media: a consensus report and guidelines.
        Eur J Radiol. 2001; 11: 1720-1728
        • Webb J.A.W.
        Repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents.
        Clin Radiol. 2005; 60: 727-730
        • Dawson P.
        • Sidhu P.S.
        Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reaction to intravascular contrast agents?.
        Clin Radiol. 1993; 38: 225-226
        • Lieberman P.
        • Kemp S.F.
        • Oppenheimer J.
        • Lang D.
        • Bernstein I.L.
        • Nicklas R.A.
        • Anderson J.A.
        • Bernstein D.I.
        • Bernstein J.A.
        • Fink J.N.
        • Greenberger P.A.
        • Ledford D.K.
        • Li J.
        • Sheffer A.L.
        • Solensky R.
        • Wolf B.L.
        The diagnosis and management of anaphylaxis: an updated practice parameter.
        J Allergy Clin Immunol. 2005; 115: S483-S523
        • American College of Radiology
        Manual on Contrast Media Version 5.0: (2004) Patient Selection and Preparation Strategies.
        (Accessed December 12, 2007)
        • Delaney A.
        • Carter A.
        • Fisher M.
        The prevention of anaphylactoid reactions to iodinated radiological contrast media: a systematic review.
        BMC Med Imaging. 2006; 6: 1-7
        • Thomsen H.S.
        • Morcos S.K.
        • Members of Contrast Media Safety Committee of the European Society of Urogenital Radiology
        Management of acute adverse reactions to contrast media.
        Eur J Radiol. 2004; 14: 476-481
        • Thomsen H.S.
        European Society of Urogenital Radiology guidelines on the safe use of iodinated contrast material.
        Euro J Radiol. 2006; 60: 307-313
        • Strait R.
        • Morris S.C.
        • Smiley K.
        • Urban J.F.
        • Finkelman F.D.
        IL-4 exacerbates anaphylaxis.
        J Immunol. 2003; 170: 3835-3842