Response

Abstract

We thank Dr Boehm for his interest in our study.1Draganov P.V. Forsmark C.E. Prospective evaluation of adverse reactions to iodine-containing contrast media after ERCP.Gastrointest Endosc. 2008; 68: 1098-1101Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar He raises 2 questions. The first relates to the most appropriate term to describe adverse reactions to contrast media (CM). As noted by Dr Boehm in his previous description, a number of terms are commonly used interchangeably, including anaphylactoid reactions, allergy-like reactions, nonallergic reactions, and hypersensitivity reactions.2Böhm I. Schild H. Contrast-media-induced hypersensitivity or allergic/allergic-like reactions? Suggestion for a more appropriate use of the nomenclature.Eur J Clin Pharmacol. 2008; 64: 931-932Crossref PubMed Scopus (16) Google Scholar The intent of these descriptions is to highlight the nonallergic nature of the reactions to CM, but, at present, there is no consensus on standard terminology. To further complicate the matter, patients with a previous reaction to CM are routinely described as “allergic to contrast” in medical records. The main objective of our article was to evaluate whether the administration of CM at the time of ERCP can lead to any adverse outcome (regardless of the exact mechanism). Therefore, in our article, we elected to use the more generic term “adverse reactions.” The second question is whether a history of shellfish allergy is a risk factor for an adverse reaction to CM. Although we are in agreement with Dr Boehm that shellfish allergy is in fact not a risk factor for an adverse reaction to CM, this is an exceedingly common misperception. In our earlier survey, we found that 52% of gastroenterologists will use prophylaxis before ERCP in patients with a shellfish allergy.3Draganov P. Cotton P.B. Iodinated contrast sensitivity in ERCP.Am J Gastroenterol. 2000; 95: 1398-1401Crossref PubMed Google Scholar In our current article,1Draganov P.V. Forsmark C.E. Prospective evaluation of adverse reactions to iodine-containing contrast media after ERCP.Gastrointest Endosc. 2008; 68: 1098-1101Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar we recorded all patient characteristics that are perceived (appropriately or inappropriately so) to be a risk factor for an adverse reaction to CM, including shellfish allergy. Application route of iodinated contrast media as a risk factor for adverse reactionsGastrointestinal EndoscopyVol. 70Issue 3PreviewTo the Editor: Full-Text PDF