Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity

Abstract

Free AccessCorrespondenceLetter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivityIngrid BöhmIngrid BöhmSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/bjr/65388056SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutThe Editor,It was with great interest I read the article by Garcia-Ortega et al [1] who presented a case with immediate reaction after iodinated contrast medium (ICM) injection. First of all I would like to congratulate the authors who published this interesting case; however, some facts remain unclear to me.First, what kind of hypersensitivity did the patient have? Angio-oedema of trunk and limbs is an unknown condition. Angio-oedema occurs in the face and involves the eyelids and lips [2]. I presume that the authors mean a generalised urticaria.Description of the clinical features is of great importance in the understanding of the pathological background, and planning of diagnostic procedures.Second, why was coronary angiography repeated 4 days later? Angiographic procedures with ICM at short intervals may be problematic, particularly in a patient with a previous immediate hypersensitivity reaction. Why was magnetic resonance angiography not considered as an alternative in this instance?Third, why was iodixanol used again? On one hand the authors present “new diagnostic tools”, and on the other the management is very old fashioned. Currently, radiologists do not usually use the ICM that has induced the hypersensitive reaction. Moreover, it is well known that pre-medication with antihistamines and corticosteroids do not prevent hypersensitive reactions. Furthermore, the doses of the drugs given 24 h before the start of the second angiography are missing in the case report.Fourth, why was the allergological work up started after the second hypersensitivity reaction?Hypersensitivity reactions after ICM reaction continue to be a challenge in radiological routine. To improve the safety of ICM application both clinical studies and case reports are of great importance. Case reports should be used to exactly describe the clinical features of adverse reactions in general, and of hypersensitivity reactions in particular [3].To conclude, in patients at high risk of hypersensitivity reaction, intradermal testing and the basophil degranulation test are of significant clinical impact, but other strategies such as avoidance of causative ICM should also be taken into account [4].References1 Garcia-Ortega P , Marin A , Quilez E , Rodriguez-Leor O . New tools for allergy diagnosis and clinical advice after immediate reactions to ICM. Br J Radiol 2010;83:632–3. Link ISI, Google Scholar2 Böhm I , Schild HH . A practical guide to diagnose less known immediate and delayed contrast media-induced adverse effects. Eur Radiol 2006;16:1570–9. Crossref Medline ISI, Google Scholar3 Böhm I , Medina J , Prieto P , Block W , Schild HH . Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence. Eur Radiol 2007;17:485–9. Crossref Medline ISI, Google Scholar4 Böhm I , Schild HH . KM-bedingte Anaphylaxie und Prävention durch Auswahl eines verträglichen Kontrastmittels. Fortschr Röntgenstr RöFo 2008;180:1127–8. Crossref Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 84, Issue 1003July 2011Pages: 581-e150 2011 The British Institute of Radiology History ReceivedNovember 23,2010AcceptedJanuary 04,2011Published onlineJanuary 28,2014 Metrics Download PDF