Iodinated contrast media allergy in patients hospitalized for investigation of chest pain

Publication date: Available online 12 April 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Guy Topaz, Adi Karas, Nuha Kassem, Yona Kitay-Cohen, David Pereg, Lotan Shilo, Adi Zoref-Lorenz, Alon Y. Hershko
BackgroundIodinated contrast media (ICM) allergy may entail severe adverse events in patients who undergo percutaneous coronary intervention (PCI). Premedication protocols and low-osmolality contrast media have been thought to improve the outcomes of these individuals. Objective: To assess the prevalence and severity of allergic reactions during PCI in patients admitted for investigation of chest pain.MethodsThis is a retrospective analysis of 13,652 patients who were hospitalized with chest pain during the years 2010-2016, at the Department of Internal Medicine, Meir Medical Center. Patient records were screened for diagnosis of prior ICM allergy. Primary outcomes were: 1) records of previous allergy to ICM; 2) administration of anti-allergic premedication; 3) allergic reactions to the ICM during the procedure.ResultsA total of 13,652 patients were screened. Nine hundred thirty one individuals without prior ICM allergy were referred for PCI, of whom 2 had minor allergic reactions. Previously diagnosed ICM allergy was recorded for 216 subjects (mean age 65.5±10 years, 42% males). Of these, 32 were referred to in-hospital PCI. Premedication was administered in 10 cases only with no documented rationale for not treating the other 22. Only one of the pre-treated patients experienced a reaction attributed to allergy, showing no statistical advantage for premedication. No mortality was documented in the 30 days following PCI among the patients with known ICM allergy.ConclusionPCI did not induce substantial allergic reactions to ICM in patients with a previously diagnosed allergy. This study did not demonstrate an advantage for premedication.