Abstract
Background and Aims: Acute urticaria (AU) is the most frequently reported immediate hypersensitivity reaction in skin by administration of iodinated contrast media (ICM). We aimed to establish the pattern and identify the risk factors of AU among inpatients undergoing non-emergent coronary angiography (CAG) with prophylactic corticosteroids in China.Methods: Medical records of 19,326 adult inpatients undergoing non-emergent CAG with prophylactic methylprednisolone in 2013–2019 were retrospectively investigated. AU was identified within 1 h post-ICM administration, and diffuse involvement was defined when wheals occur in two or more body parts, including the back, abdomen, chest, and extremities. Age- and sex-matched inpatients (1:4) without AU were randomly selected for assessment of risk factors.Results: Approximately 0.8% of CAG inpatients had AU, including 101 diffuse and 64 limited form. The diffuse AU was more common in settings of non-diagnostic CAG, iohexol used, average ICM injection≥3 ml/min, recurrent CAG, and past history of immediate hypersensitivity to ICM. Inpatients with preexisting allergies, decreased evaluated glomerular filtration rate, and increased high sensitivity C reactive protein or neutrophil-to-lymphocyte ratio prior to CAG had a higher probability of AU (odds ratio >1, P < 0.05 for all variables). All AU inpatients complained of pruritus, and mild itching predominated. AU dissipated in several days under treatment of ebastine or levocetirizine 10 mg/daily, but ebastine showed superiority.Conclusions: ICM-induced AU is not uncommon in non-emergent CAG inpatients with prophylactic methylprednisolone. Preexisting allergies, renal dysfunction, and mild inflammation are high-risk factors, and antihistamine monotherapy is a favorable candidate for ICM-related AU.
Highlights
Iodinated contrast media (ICM) is indispensable and invaluable for enhancing the quality of imaging by improving the visibility of specific organs, blood vessels, or tissues
During the designated 7 years, a total of 24,058 non-emergent coronary angiography (CAG) in 19,326 patients were conducted, while acute urticaria (AU) occurred in 0.8% (165/19,326) of the patients
More patients showed diffuse AU than limited AU (61.2 vs. 38.8%, P = 0.018), which was observed in subgroups of general interventional CAG (P = 0.029), chronic total occlusion (CTO) interventional CAG (P < 0.001), application of iohexol (P = 0.018), average ICM injection speed more than 3 ml/min (P = 0.001), recurrent CAG (P = 0.048), and past history of immediate hypersensitivity reactions (HSRs) to ICM during CAG (P = 0.012)
Summary
Iodinated contrast media (ICM) is indispensable and invaluable for enhancing the quality of imaging by improving the visibility of specific organs, blood vessels, or tissues. It is estimated that over 100 million ICM-requiring procedures are performed annually worldwide and are increasing by 20% annually in China [1, 2]. ICM-related HSRs comprise a broad range of clinical features with involvement of most organ systems. They can be generally classified as immediate or delayed HSRs, occurring within 1 h or 1 h−2 weeks post-ICM administration, respectively [5]. Immediate HSRs to ICM usually show cutaneous symptoms with acute limited or diffuse urticaria [6]. Acute urticaria (AU) is the most frequently reported immediate hypersensitivity reaction in skin by administration of iodinated contrast media (ICM). We aimed to establish the pattern and identify the risk factors of AU among inpatients undergoing non-emergent coronary angiography (CAG) with prophylactic corticosteroids in China
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