Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstract for Reference 43

of 'Immediate hypersensitivity reactions to radiocontrast media: Clinical manifestations, diagnosis, and treatment'

Anaphylaxis to iodinated contrast media: clinical characteristics related with development of anaphylactic shock.
Kim MH, Lee SY, Lee SE, Yang MS, Jung JW, Park CM, Lee W, Cho SH, Kang HR
PLoS One. 2014;9(6):e100154. Epub 2014 Jun 16.
OBJECTIVE: Anaphylaxis is the most severe form of radiocontrast media (RCM) induced hypersensitivity and can be life-threatening if profound hypotension is combined. With increased use of iodine based RCM, related hypersensitivity is rapidly growing. However, the clinical characteristics and risk factors of RCM induced anaphylaxis accompanied by hypotension (anaphylactic shock) are not clearly defined. This study was performed to investigate the risk factors of RCM induced anaphylactic shock and the clinical value of RCM skin testing to identify causative agents in affected patients.
METHODS: We analyzed the data of RCM induced anaphylaxis monitored by an inhospital pharmacovigilance center at a tertiary teaching hospital from January 2005 to December 2012 and compared the clinical features and skin test results according to the accompanying hypotension.
RESULTS: Among total of 104 cases of RCM induced anaphylaxis, 34.6% of patients, developed anaphylaxis on their first exposure to RCM. Anaphylactic patients presenting with shock were older (57.4 vs. 50.1 years, p = 0.026) and had a history of more frequently exposure to RCM (5.1±7.8 vs. 1.9±3.3, p = 0.004) compared to those without hypotension. Among RCMs, hypotension was more frequent in anaphylaxis related to iopromide compared to other agents (85.0% vs. 61.4%, p = 0.011). Skin tests were performed in 51 patients after development of RCM induced anaphylaxis. Overall skin test positivity to RCM was 64.7% and 81.8% in patients with anaphylactic shock.
CONCLUSION: RCM induced anaphylactic shock is related to multiple exposures to RCM and most patients showed skin test positivity to RCM.
Department of Internal Medicine, Division of Allergy and Clinical Immunology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea; Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Republic of Korea; Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea.