JACC. Case reports · 2025
When Premedication Fails: Anaphylaxis to Iodinated Contrast Media in the Cardiac Catheterization Lab Despite Premedication.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Trinh Anthony T, McMurray Jeremy C, Pittman Luke M, Ryaboy Ilya V
Аннотация
BACKGROUND: IgE-mediated anaphylaxis to iodinated contrast media (ICM) is rare but potentially life threatening. Unlike non-IgE-mediated reactions, cases are often resistant to corticosteroid and antihistamine premedication.
CASE SUMMARY: A patient with a history of anaphylaxis to Visipaque contrast was referred for invasive coronary angiography. Despite premedication, she developed hypotensive anaphylaxis requiring immediate case cessation and emergent treatment with epinephrine. Subsequent allergy evaluation with skin testing identified an alternative contrast agent, allowing successful percutaneous coronary intervention without further reactions.
DISCUSSION: Cardiovascular angiography guidelines recommend premedication for prior contrast media reactions but provide limited guidance for recurrent, severe cases. Allergy consultation with skin testing represents an effective strategy to identify safe alternative agents in cases with suspected IgE-mediated ICM reactions.
TAKE-HOME MESSAGES: Although rare, severe IgE-mediated ICM reactions are clinically significant and classically unresponsive to premedication. Allergy consultation and alternative agent selection via skin testing can enable safe contrast-enhanced procedures.
CASE SUMMARY: A patient with a history of anaphylaxis to Visipaque contrast was referred for invasive coronary angiography. Despite premedication, she developed hypotensive anaphylaxis requiring immediate case cessation and emergent treatment with epinephrine. Subsequent allergy evaluation with skin testing identified an alternative contrast agent, allowing successful percutaneous coronary intervention without further reactions.
DISCUSSION: Cardiovascular angiography guidelines recommend premedication for prior contrast media reactions but provide limited guidance for recurrent, severe cases. Allergy consultation with skin testing represents an effective strategy to identify safe alternative agents in cases with suspected IgE-mediated ICM reactions.
TAKE-HOME MESSAGES: Although rare, severe IgE-mediated ICM reactions are clinically significant and classically unresponsive to premedication. Allergy consultation and alternative agent selection via skin testing can enable safe contrast-enhanced procedures.