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Gelbenegger G, Buchtele N, Schoergenhofer C, Grafeneder J, Schwameis M, Schellongowski P, Denk W, Jilma B. Disseminated Intravascular Coagulation in Anaphylaxis. Semin Thromb Hemost 2024; 50:569-579. [PMID: 38029783 DOI: 10.1055/s-0043-1776878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Anaphylaxis is a life-threatening condition that involves severe cutaneous, respiratory, and cardiovascular symptoms. Disseminated intravascular coagulation (DIC) is an acquired, widespread activation of coagulation that can be caused by infectious conditions (e.g., sepsis) and noninfectious conditions. The onset of DIC following anaphylaxis is not commonly known, and information regarding the pathomechanism linking anaphylaxis to DIC is scarce. Further, demographic and clinical data in anaphylaxis-induced DIC are still missing to this day. Triggered by a case of anaphylaxis-induced DIC that seamlessly transitioned to lethal sepsis-induced DIC, we aimed to characterize the patient population affected by anaphylaxis-induced DIC by performing a review of existing literature and expand the discussion to underlying mechanisms. The overall mortality of the patient cohort (n = 30) identified by the literature review was 50%. All patients that died either suffered a bleeding event or a thrombotic event. The majority of patients (n = 25/30; 83%) had bleeding events; thrombotic events were only reported in nonsurvivors (n = 9/15 or 60% of nonsurvivors; vs. n = 0/15 in survivors; p < 0.001). Nonsurvivors of anaphylaxis-induced DIC were on average 25 years older than survivors (p = 0.068). In conclusion, DIC can complicate anaphylaxis and is expected to contribute to poor microvascular perfusion after anaphylaxis. Particularly, elderly patients with known cardiovascular disease and patients who develop thrombotic events are susceptible to lethal outcomes. As a rare and largely uncharacterized disease entity, further research is needed to investigate the link between DIC and anaphylaxis and to potentially identify better treatment strategies.
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Affiliation(s)
- Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | | | - Jürgen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Denk
- Austrian Society of Forensic Medicine, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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2
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Sullivan CM, Paul NS, Rieder MJ. Bridging the gap between bench and clinic: the importance of understanding the mechanism of iodinated contrast media hypersensitivity. Br J Radiol 2023; 96:20220494. [PMID: 36395475 PMCID: PMC10997019 DOI: 10.1259/bjr.20220494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Since the advent of CT, iodinated contract media (ICM) has become one of the most regularly administered intravenous medications in clinical settings. Although considered generally safe, ICM is one of the most common causes of adverse drug reactions in clinical practice, accounting for more than 2 million adverse reactions worldwide. Currently, there are few useful tools to diagnose patient hypersensitivity, with the major limitation being the lack of consensus regarding the mechanisms of hypersensitivity to ICM. While there is an overwhelming abundance of literature pertaining to clinical features including incidence, symptomatology, and risk, few studies have further investigated the underlying mechanisms behind their clinical observations. Of the available literature discussing pathophysiology, most primary studies were completed over 20 years ago, since which the molecular characteristics of ICM have changed. Furthermore, many reviews mentioning pathophysiology fail to adequately emphasize the clinical importance of understanding the molecular pathways involved in hypersensitivity. In this review, we aim to emphasize the clinical relevance of pathophysiology as it relates to the prediction and diagnosis of hypersensitivity reactions to ICM. To this end, we will first briefly characterize hypersensitivity reactions to ICM with respect to epidemiology and clinical presentation. We will then present the existing evidence supporting various proposed mechanisms of hypersensitivity, highlighting the gaps that remain in the mechanistic delineation of both immediate and delayed reactions. Finally, we discuss the possibility of in vitro testing as a way to predict and diagnose hypersensitivity reactions, pending a more complete elucidation of mechanisms.
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Affiliation(s)
- Caitlin M Sullivan
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
| | - Narinder S Paul
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
| | - Michael J Rieder
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
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Calabrese LH, Kavanaugh A, Yeo AE, Lipsky PE. Frequency, distribution and immunologic nature of infusion reactions in subjects receiving pegloticase for chronic refractory gout. Arthritis Res Ther 2017; 19:191. [PMID: 28818095 PMCID: PMC5561590 DOI: 10.1186/s13075-017-1396-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess frequency and distribution of infusion reactions (IRs) in responders and nonresponders in randomized clinical trials (RCTs) of intravenous pegloticase and the utility of the National Institute of Allergy and Infectious Disease/Food and Allergy and Anaphylaxis Network (NIAID/FAAN) criteria for identifying anaphylaxis in subjects experiencing IRs. METHODS IRs from two RCTs of pegloticase were evaluated and categorized as anaphylaxis, hypersensitivity, or other. Serum levels of tryptase and total hemolytic complement (CH50) were evaluated at the time of all IRs. Frequency of IRs by each category was evaluated in all subjects, responders or nonresponders to pegloticase. RESULTS There were 113 IRs in 1695 infusions. Of the 113 IRs, 6 met criteria for anaphylaxis, 53 had one feature of anaphylaxis and were designated as "hypersensitivity", and 54 had no features and were designated "other". In subjects receiving pegloticase every 2 weeks (Q2w), a total of 852 infusions were administered and the IR frequency was 0.5% in responders and 9.7% in nonresponders. In subjects receiving pegloticase every 4 weeks (Q4w), a total of 846 infusions were given and the IR frequency was 2.6% in responders and 12.2% in nonresponders. There were no differences among the three categories of IRs with regard to clinical course or biochemical evidence of immune activation determined by CH50 or tryptase levels. CONCLUSION IRs mostly occurred in nonresponders. NIAID/FAAN criteria for anaphylaxis did not identify pegloticase-related IRs as having a higher frequency of immune activation or a more severe course. The results are consistent with the conclusion that discontinuance of pegloticase if uric acid rises to >6 mg/dL will decrease the frequency of IRs.
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Affiliation(s)
- Leonard H Calabrese
- Cleveland Clinic, Department of Rheumatic & Immunologic Diseases, Cleveland, OH, 44195, USA
| | - Arthur Kavanaugh
- University of California San Diego, Division of Rheumatology, Allergy and Immunology, La Jolla, CA, 92093, USA
| | | | - Peter E Lipsky
- AMPEL BioSolutions, LLC, 250 W. Main Street, Charlottesville, VA, 22902, USA.
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Abstract
The under agarose method for evaluation of leucocyte chemotaxis was used to investigate the effect of radiographic contrast media (CM) on granulocyte locomotion. The CM tested had no chemoattractive properties. CM inhibited N-fmlp, a synthetic formylated Met-tripeptide, which is a strong chemotactic agent and an analogue to chemotatic peptides produced by bacteria. The inhibition of N-fmlp was most pronounced for diatrizoate. Equiosmolal saline was not so inhibitive. Therefore, some part of the inhibition was caused by factor(s) other than hyperosmolality inherent in the CM solution.
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Mertes PM, Demoly P, Malinovsky JM. Complications anaphylactiques et anaphylactoïdes de l’anesthésie générale. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0289(12)59003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Böhm I, Schild HH. A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions. Eur Radiol 2006; 16:1570-9. [PMID: 16770655 DOI: 10.1007/s00330-006-0202-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 01/11/2006] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Abstract
The terms "immediate" and "delayed" adverse reactions induced by contrast media (CM) refer to the reactions' onset but do not provide substantial information concerning the clinical manifestation, the potential risk factors, the treatment modalities, or prevention. Because a variety of different reactions caused by different pathophysiological mechanisms may arise immediately or be delayed after CM injection, and because these need different management, the aim of the present paper is to present the clinical features and to exactly characterize lesser-known cutaneous reactions. A thorough knowledge of the clinical features, their adequate treatment, and, possibly, the subsequent diagnostic procedure for preventing recurrence after reexposure to CM would improve patient management.
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Affiliation(s)
- Ingrid Böhm
- Department of Radiology, University of Bonn, Sigmund-Freud Strasse 25, 53105, Bonn, Germany.
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Szebeni J. Complement activation-related pseudoallergy: a new class of drug-induced acute immune toxicity. Toxicology 2005; 216:106-21. [PMID: 16140450 DOI: 10.1016/j.tox.2005.07.023] [Citation(s) in RCA: 417] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 07/18/2005] [Accepted: 07/28/2005] [Indexed: 02/06/2023]
Abstract
A major goal in modern pharmacotechnology is to increase the therapeutic index of drugs by using nanoparticulate vehicle systems in order to ensure slow release or targeted delivery of drugs. With all great benefits, however, these innovative therapies can carry a risk for acute immune toxicity manifested in hypersensitivity reactions (HSRs) that do not involve IgE but arises as a consequence of activation of the complement (C) system. These anaphylactoid reactions can be distinguished within the Type I category of HSRs as "C activation-related pseudoallergy" (CARPA). Drugs and agents causing CARPA include radiocontrast media (RCM), liposomal drugs (Doxil, Ambisome and DaunoXome) and micellar solvents containing amphiphilic lipids (e.g., Cremophor EL, the vehicle of Taxol). These agents activate C through both the classical and the alternative pathways, giving rise to C3a and C5a anaphylatoxins that trigger mast cells and basophils for secretory response that underlies HSRs. Pigs provide a useful model for liposome-induced CARPA as minute amounts of reactogenic lipomes cause C activation with consequent dramatic cardiovascular and laboratory abnormalities that mimic some of the human symptoms. Consistent with the causal role of C activation in liposome-induced HSRs, a recent clinical study demonstrated correlation between the formation of C terminal complex (SC5b-9) in blood and the presence of HSRs in patients treated with liposomal doxorubicin (Doxil). Overall, the CARPA concept may help in the prediction, prevention and treatment of the acute immune toxicity of numerous state-of-the-art drugs.
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Affiliation(s)
- Janos Szebeni
- Department of Vaccine Production and Delivery, Division of Retrovirology, Walter Reed Army Institute of Research and Henry Jackson Foundation for Military Medical Research, Silver Spring, MD, USA.
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8
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Szebeni J. Hypersensitivity reactions to radiocontrast media: the role of complement activation. Curr Allergy Asthma Rep 2004; 4:25-30. [PMID: 14680617 DOI: 10.1007/s11882-004-0038-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although intravenous use of radiocontrast media (RCM) for a variety of radiographic procedures is generally safe, clinically significant acute hypersensitivity reactions still occur in a significant percentage of patients. The mechanism of these anaphylactoid, or "pseudoallergic," reactions is complex, involving complement activation, direct degranulation of mast cells and basophils, and modulation of enzymes and proteolytic cascades in plasma. In this review, basic information on different RCMs and their reactogenicity is summarized and updated, and the prevalence, pathomechanism, prediction, prevention, treatment, and economic impact of hypersensitivity reactions are discussed. Particular attention is paid to the in vitro and in vivo evidence supporting complement activation as an underlying cause of RCM reactions.
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Affiliation(s)
- Janos Szebeni
- Department of Membrane Biochemistry, Walter Reed Army Institute of Research, 501 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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9
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Mertes PM, Dewachter P, Laxenaire MC. Complications anaphylactiques et anaphylactoïdes de l'anesthésie générale. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s0246-0289(03)00098-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Rodriguez RM, Guéant JL, Aimone-Gastin I, Gérard P, Amoghly F, Bellou A, Jullière Y, Faure G, Danchin N, Romano A. The increased histamine release in ischaemic heart disease patients undergoing coronaroangiography is not mediated by specific IgE. Allergy 2002; 57 Suppl 72:61-6. [PMID: 12144558 DOI: 10.1034/j.1398-9995.57.s72.17.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The release of histamine by iodinated contrast media (ICM) is higher in coronary artery disease patients than in noncoronary patients during coronary angiogram. METHODS Eighty-eight patients who underwent a coronary angiography were classified either as having coronary artery disease or as noncoronary patients. Histamine concentration was higher than the 6.8 nM upper limit in 7 cases (group 1), of whom six were coronary artery disease patients. We compared the IgE and complement fractions in plasma of these patients to two control groups with normal histamine blood level, one (group 2) with and the other (group 3) without coronary artery disease. RESULTS No difference of total IgE and C(3c) and C(4) complement fractions was found among the three groups. Anti-ioxaglate IgE-RIA was positive in only one patient from group 1. The affinity of drug-IgE binding in the serum of this patient was very low (Kd: 18.7 mM). The level of anti-ICM IgE detected by ioxitalamate- and iomeprol-Sepharose RIA was significantly higher in groups 2 and 3 than in group 1. CONCLUSIONS The higher histamine release in ischaemic heart disease patients undergoing coronaroangiography is not mediated by IgE or complement activation. Further studies are needed to investigate the implication of histamine release factors.
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Affiliation(s)
- Rosa-Maria Rodriguez
- Laboratoire de Pathologie Cellulaire et Moléculaire en Nutrition, Equipe INSERM 0014, Faculté de Médecine, BP 184, F-54505 Vandoeuvre-lès-Nancy Cedex, France
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11
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Rodriguez RM, Guéant JL, Gastin IA, Angioi M, Abdelmoutaleb I, Saint-Laudy J, Gérard P, Namour F, Grentzinger A, Romano A, Juillière Y, Danchin N. Comparison of effects of ioxaglate versus iomeprol on histamine and tryptase release in patients with ischemic cardiomyopathy. Am J Cardiol 2001; 88:185-8, A6. [PMID: 11448422 DOI: 10.1016/s0002-9149(01)01620-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We observed a release of histamine, but not of tryptase, in arterial blood from 64 patients with ischemic heart disease and 24 patients without coronary disease, which was provoked by ioxaglate, a ionic compound, but was not provoked by iomeprol, a non-ionic radiocontrast compound. The release of histamine in arterial blood after ionic contrast medium injection was higher in patients with ischemic heart disease compared with patients without coronary disease, suggesting that an increased release from heart mast cells previously observed exists also for systemic blood basophils.
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Affiliation(s)
- R M Rodriguez
- Service de Cardiologie, CHU de Nancy-Brabois, Vandoeuvre, France.
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12
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Lieberman PL, Seigle RL. Reactions to radiocontrast material. Anaphylactoid events in radiology. Clin Rev Allergy Immunol 2000; 17:469-96. [PMID: 10829816 DOI: 10.1007/bf02737651] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Laroche D, Namour F, Lefrançois C, Aimone-Gastin I, Romano A, Sainte-Laudy J, Laxenaire MC, Guéant JL. Anaphylactoid and anaphylactic reactions to iodinated contrast material. Allergy 1999. [DOI: 10.1111/j.1398-9995.1999.tb04742.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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15
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Shigyo M, Tsukamoto T, Yanase M, Kumamoto Y, Aoki M, Katsumata K. A Rare Case of Disseminated Intravascular Coagulation Caused by the Nonionic Contrast Medium Iohexol. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67347-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Masanori Shigyo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo and Department of Urology and Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Taiji Tsukamoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo and Department of Urology and Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Masahiro Yanase
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo and Department of Urology and Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Yoshiaki Kumamoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo and Department of Urology and Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Masaharu Aoki
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo and Department of Urology and Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Kazuaki Katsumata
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo and Department of Urology and Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
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16
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Lieberman P. ANAPHYLACTOID REACTIONS TO RADIOCONTRAST MATERIAL. Immunol Allergy Clin North Am 1992. [DOI: 10.1016/s0889-8561(22)00134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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17
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Lieberman P. Anaphylactoid reactions to radiocontrast material. CLINICAL REVIEWS IN ALLERGY 1991; 9:319-38. [PMID: 1723654 DOI: 10.1007/bf02802311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- P Lieberman
- Department of Medicine, University of Tennessee, Memphis
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18
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Lasser EC. Pseudoallergic Drug Reactions. Immunol Allergy Clin North Am 1991. [DOI: 10.1016/s0889-8561(22)00062-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Rasmussen F, Antonsen S, Georgsen J. Granulocyte enzymes and complement after an anaphylactoid reaction to coronary angiography. Eur J Radiol 1991; 13:46-9. [PMID: 1889429 DOI: 10.1016/0720-048x(91)90055-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An anaphylactoid reaction following angiography with ioxaglate in a 59-year-old man implied generalized pruritus, angioedema, bronchospasm and hypotension. Leucocytosis and an increased number of neutrophils were observed from 90 min to 8 h after the reaction. Elevated values of the neutrophil specific enzymes elastase and lactoferrin were demonstrated. The concentrations of C3d and CH50 did not change which indicate that no complement activation took place.
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Affiliation(s)
- F Rasmussen
- Department of Diagnostic Radiology, Odense University Hospital, Denmark
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Abstract
Hypocomplementemia is an important marker for the presence of IC-mediated disease and can be used to assess disease activity. However, in interpreting the clinical significance of hypocomplementemia, the following must be kept in mind: 1) There are numerous non-immunologic conditions that also can cause hypocomplementemia. Furthermore, some of these conditions can cause a multisystem disease that, along with the hypocomplementemia, can closely resemble an IC-mediated systemic vasculitis. Furthermore, these nonimmunologic conditions that lower serum complement levels can complicate the course of patients with inactive IC-mediated disease, spuriously indicating that the disease is active. The most relevant of these differential diagnostic problems are listed in Table 2. 2) There are a few conditions (for example, pregnancy) that can raise serum complement levels, thereby possibly obscuring the presence of a disorder (such as, active SLE) that is lowering complement levels. 3) There are some conditions that might be expected to lower serum complement levels, because of their effect on protein metabolism, but do not. Nephrotic syndrome, and moderately poor nutrition are examples. All of these factors should be considered when interpreting results of serum complement levels in a given patient.
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Eloy R, Corot C, Belleville J. Contrast media for angiography: physicochemical properties, pharmacokinetics and biocompatibility. CLINICAL MATERIALS 1990; 7:89-197. [PMID: 10149134 DOI: 10.1016/0267-6605(91)90045-h] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contrast agents are used as diagnostic molecules for the visualization of the vascular system. Despite their rapid pharmacokinetic distribution, and their excretion within a few minutes, their injection is associated with clinical symptoms of relative bioincompatibility. Allergoid reactions and disturbances of the hemostatic system represent the main fields of biological investigations. Due to the extent of clinical and experimental works the ubiquitous interactions between these molecules and cellular and/or protein systems have emerged. The development of a new family of low osmolality ionic or non-ionic contrast molecules had decreased the incidence of minor reactions, but did not modify the frequency of severe accidents and even led to the emergence of new iatrogenic syndromes. Despite extensive laboratory investigations there are still no predictive criteria nor any specific therapeutic prevention of these allergoid reactions. The suggested future line of investigation concerns the physicochemical interaction of CM and targeted biological systems which may allow the analysis and predictivity of these interactions at the molecular level.
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Affiliation(s)
- R Eloy
- Unit 37 Inserm, Bron, France
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22
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Affiliation(s)
- P A Greenberger
- Department of Medicine, Northwestern University Medical School, Chicago, IL
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23
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Lieberman P, Siegle RL, Treadwell G. Radiocontrast reactions. CLINICAL REVIEWS IN ALLERGY 1986; 4:229-45. [PMID: 2870792 DOI: 10.1007/bf02991111] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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24
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Affiliation(s)
- D J Ligresti
- Department of Dermatology, Mt. Sinai School of Medicine, New York, New York
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25
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Erffmeyer JE, Siegle RL, Lieberman P. Allergy grand rounds. Anaphylactoid reactions to radiocontrast material. J Allergy Clin Immunol 1985; 75:401-10. [PMID: 3973314 DOI: 10.1016/0091-6749(85)90079-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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26
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Mohan JC, Reddy KS, Bhatia ML. Anaphylactoid reaction to angiographic contrast media: recurrence despite pretreatment with corticosteroids. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1984; 10:465-9. [PMID: 6518509 DOI: 10.1002/ccd.1810100507] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case who developed severe and potentially fatal reaction to an angiographic contrast medium despite adequate pretreatment with steroids for 2 weeks is reported. This is the second such case reported in the English literature.
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27
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Assem ES, Bray K, Dawson P. The release of histamine from human basophils by radiological contrast agents. Br J Radiol 1983; 56:647-52. [PMID: 6192864 DOI: 10.1259/0007-1285-56-669-647] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The capacity of conventional and new low-osmolality contrast agents to stimulate histamine release from human basophils has been studied in vitro. When compared on an iodine concentration basis, the new agents release less histamine than the conventional agents at intermediate and higher concentration. However, the newer compounds exhibit a biphasic histamine release response to increasing iodine concentration with a low concentration peak, a phenomenon not previously described. Among the conventional ionic agents, meglumine salts were confirmed to be more potent histamine releasers than sodium salts. Possible mechanisms of this histamine release and the bearing of the findings on the safety of contrast media are discussed.
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Abstract
Adverse reactions to intravascular administration of contrast media, while low in incidence, merit serious consideration in view of increased utilization of these substances all over the world. Evidence for involvement of soluble mediators, antibody-antigen reactions, psychogenic factors, and the acute activation systems, is reviewed. As a group, the pre-contrast challenge plasmas of reactors are characterized by slightly diminished concentrations of Cl-esterase inhibitor and total hemolytic complement, and by an accelerated rate of conversion of prekallikrein to kallikrein on exposure to contact activators. The role of intravenous pretesting and pretreatment is considered. A rationale for pretreatment with adrenocorticosteroids is presented.
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