Adverse Reactions To Contrast Media Research Articles

Comparative Analysis of Death-Related Iodide Contrast Media due to Adverse Reactions of Contrast Media in Computed Tomography

Comparative Analysis of Death-Related Iodide Contrast Media due to Adverse Reactions of Contrast Media in Computed Tomography

Application of comprehensive nursing care in enhanced CT scan

Objective To explore the effects of comprehensive nursing care on adverse reactions of contrast media in enhanced CT scan. Methods From November to December 2016, we selected 4 413 patients with enhanced CT scan in Cancer Hospital of Peking Union Medical College. All of the patients were divided into control group and observation group with the random number table. There were 2 010 cases in control group with routine nursing, while there were 2 403 patients in observation group with comprehensive nursing. We observed the adverse reactions and satisfaction with nursing among patients with enhanced CT scan between two groups. Results The incidence of adverse reactions of observation group was lower than that of control group; the patients' satisfaction with nursing of observation group was higher than that of control group; the differences were all statistical (P<0.05) . Conclusions Comprehensive nursing care can reduce the incidence of adverse reactions of contrast media and improve satisfaction with nursing among patients with enhanced CT scan. Key words: Nursing care; Adverse reactions; Enhanced CT scan; Contrast media; Nursing satisfaction

Difference in Total Serum Immunoglobulin E Level Among Patients With and Without Intravenous Contrast Media Adverse Reaction on Computed Tomography Scan Examination

The adverse reaction (AR) to intravenous contrast media (ICM) are relatively common. Various opinions pro-posed in the mechanism of the incidence of ICM AR. Suspected that the role of Immunoglobulin E (IgE) me-diates allergic conditions that are part of the AR. Objective:To determine the difference in total serum IgE level among subjects with and without ICM AR on computed tomography (CT) scan examination. To ob-serve difference in total serum IgE levels in subjects undergoing ICM adverse reaction based on the degree of severity. Method: An analytical study with cross-sectional design of 104 subjects undergoing CT scans with ICM, examined IgE levels before and after ICM was administered, then measured the severity of adverse re-actions of contrast media. Result: In this study, subjects undergoing adverse reactions, prior to administration Iopamidol had a higher mean IgE 1270.79 mg / dl compared with those who having AR 1174.90 mg / dl and after administration of Iopamidol a mean of Ig E is still higher in subjects having AR 1507.96 mg/dl com-pared with those having negative AR that is 1325.88 mg/dl, p = 0.696, statistically, not significant. Mild reac-tions in 40 subjects (38.5%) with cough, nausea, dizziness, itching, and sweating. Conclusion: Increase in total IgE levels in subjects with positive adverse reactions are independent(p=0.696).

Risk Evaluation of Endoscopic Retrograde Cholangiopancreatography-Related Contrast Media Allergic-Like Reaction: A Single Centre Experience.

Background and Aims. Few cases of endoscopic retrograde cholangiopancreatography- (ERCP-) related contrast media (CM) adverse reactions have been reported in the current literature. There is a lack of standardisation in practice regarding premedication prophylaxis for at-risk patients undergoing ERCP and there are few data to guide the practitioners. Our goal is to evaluate the risk of CM adverse reaction in a group of patients with a past history of allergic-like reaction to iodine product undergoing ERCP. Methods. A retrospective chart review study was performed of patients who underwent ERCP at our single centre from January 2010 to December 2015. Results. 2295 ERCPs were performed among 1766 patients. No anaphylactoid or severe adverse reaction occurred. One (0.04%) ERCP-related CM benign reaction was reported in a patient known for penicillin allergy. Among 127 ERCPs performed on patients with a prior adverse reaction to iodine, 121 procedures were done without and 6 with a premedication prophylaxis. In both groups, no ERCP-related CM reaction occurred. Conclusions. To our knowledge, we report the largest cohort of iodine allergic patients undergoing ERCP ever published. These results suggest that ERCP-related CM adverse reactions are very rare even among patients at risk for CM reaction.

Prevalence and clinical features of hypersensitivity reaction to contrast media after prescreening skin test

Purpose: Hypersensitivity reactions to contrast media (CM) are one of the most common causes of drug adverse reactions. The overall prevalence of immediate hypersensitivity reaction (IHR) was 0.16%-7.7% to nonionic CM. Although IHR to CM has been tra ditionally considered nonallergic, there is growing evidence that the mechanism of IHR to CM is mediated by IgE. It can be severe, even fatal, and a legal problem. To reduce IHR, the prescreening skin test is on the rise. Methods: We reviewed cases of IHR to CM during enhanced computed tomography (CT) from 2008 to 2015 at a secondary hospital in South Korea. Patients who underwent enhanced CT were performed the 2-step prescreening skin test before nonionic CM-en hanced CT. If patients had adverse reactions to CM, the reactions were reported. IHR to CM was defined as an immediate reaction within 1 hour after CM administration. The Ring and Messmer system was used to classify the severity of reactions by grades I to IV, and we defined grades III and IV as severe reactions. Results: A total of 30,105 CM-enhanced CT cases were recruited from 2008 to 2015. A total 46 patients with CM adverse reactions were reported. The IHR were noted in 30 of the total patients (0.1%), of which 6 had severe reaction. Conclusion: The prevalences of IHR and severe IHR to CM were 0.1% and 0.02%, respectively. Further studies are needed to evaluate the usefulness of prescreening skin tests to prevent IHR to CM. (Allergy Asthma Respir Dis 2016:4:442-448)

Evaluation of adverse reactions to contrast media in the hospital

To determine and analyse the characteristics of contrast media adverse reactions (CM-ARs) reported in a hospital. A retrospective review of CM-ARs from the electronic spontaneous adverse drug reaction (ADR) report system between January 2011 and August 2012 was conducted. CM-ARs were evaluated in terms of causality, severity, preventability and affected organs. Also, agreement and correlation among the tools used to evaluate CM-ARs were analysed. The overall reaction rate was 1.5% (n = 286). In total, 269 CM-ARs were identified. For ADR causality, 96.7% (n = 260) and 98.5% (n = 265) were evaluated as "probable" ADR using the Naranjo probability scale and the World Health Organization-Uppsala Monitoring Centre causality categories, whereas 98.1% (n = 264) were evaluated as "certain" with Korean algorithm v. II. Of these, 91.4% (n = 246) were mild in severity and 96.7% (n = 260) were unpreventable. Most patients (n = 233, 86.7%) could be managed with observation and/or simple treatment. The most frequent reaction (n = 383, 79.5%) was dermatological. Spearman's correlation coefficient was 0.667 (p < 0.01), and the agreement was 98.1% between the Naranjo scale and the World Health Organization-Uppsala Monitoring Centre categories. No relationship was seen between CM-AR severity and gender or between in- and outpatients. In our study, most CM-ARs were mild and managed with simple treatment. However, as the number of patients undergoing CT procedures continues to increase, it is essential to identify and observe patients at risk for CM-ARs to prevent severe ADRs. Continuous careful review of reporting and treatment protocols of CM-ARs is needed to prevent morbidity and mortality.

Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome – the results of a 3-year period

Iodinated contrast media (CM) are commonly used. Hypersensitivity reactions to CM occasionally result in morbidity. Risk factors and the role of premedication remain to be investigated. We sought to explore the prevalence, risk factors and outcome of CM reactions. The retrospective case-control study was conducted between 2008 and 2010. In total, 55,286 subjects who were exposed to iodinated CM were enrolled to determine the prevalence of CM reactions. The case-control statistical method was applied to determine the risk factors of CM reactions. 579 subjects who had CM reactions were categorised in the case group and 1,175 of the 55,286 subjects who had tolerated CM exposure were randomised for the control group. The overall prevalence of CM reactions was 1.05%. In a multivariate analysis, the history of previous CM reactions, female gender and the history of seafood allergy were significant risk factors for CM reactions. The significant risk factors for the first episode of CM reactions were female gender, the history of seafood allergy and asthma. We found sixteen serious reactions in the immediate reaction group: ten fully recovered after hospitalisation, five fully recovered after out-patient treatment and one died after the administration of CM via an intra-arterial route during coronary angiogram. The most significant risk factor associated with serious reactions was asthma, whereas comorbid cardiovascular disease, male gender, history of seafood allergy and history of previous CM reactions were significant risk factors for mild reactions. The prevalence of CM adverse reactions was as low as 1.05%. Risk factors consist of a history of previous CM reactions, female gender and seafood allergy. Nevertheless, serious immediate reactions could occur particularly in patients with asthma.

Incidence and severity of acute adverse reactions to intravenous iodinated contrast media: 8-year experience in King Chulalongkorn Memorial Hospital

Background: Increasing numbers of acute adverse reactions to contrast media are being seen. Institutional information about incidence and severity of acute adverse reactions to contrast media is essential to inform radiologists of the both common and life-threatening acute adverse reactions encountered. Objectives: We determined the overall, type-specific and severity of acute adverse reactions to intravenous iodinated contrast media at King Chulalongkorn Memorial hospital between January 2002 and December 2009. Methods: This retrospective study reviewed 663 report forms for acute adverse reactions to contrast media among 74,010 intravenous iodinated contrast injections using five types of contrast media including meglumine/sodium ioxitalamate, iohexol, iopamidol, iopromide, and iobitridol. Results: The overall incidence of acute adverse reactions to iodinated contrast media was about 0.9%. Of these 0.8% were minor, and 0.1% were major reactions. The majority of minor reactions were urticaria and the majority of major reactions were facial edema. One contrast-related death was reported. Incidence of acute adverse reactions to nonionic contrast media was 0.58%, and was 4.29 % in the ionic group. The type-specific incidence of acute adverse reactions was 4.29% for meglumine/sodium ioxitalamate, 0.82% for iohexol, 0.29% for iopamidol, 0.65% for iopromide, and 0.25% for iobitridol. Conclusion: Acute adverse reactions to intravenous iodinated contrast media account for less than one percent of injections. The incidence is higher in the ionic contrast media group. The majority of reactions are mild. However, severe reactions can still be encountered and death related to contrast media exist. Keywords: Acute adverse reactions, contrast media, intravenous, iodinated, incidence, severity

A Review of Clinical Practice in Contrast Media Adverse Reactions

A Review of Clinical Practice in Contrast Media Adverse Reactions

Adverse reactions to contrast media: An analysis from spontaneous reporting data

Diagnostic contrast media (CM) are a widely used class of drugs with poor information regarding their safety. Nevertheless, epidemiological studies showed that CM cause adverse reactions commonly considered unpreventable and unavoidable. Because spontaneous reporting is a valuable methodology for better defining the safety profile of drugs after their approval, we analyzed the spontaneous reports of suspected adverse reactions attributed to CM sent to the Sicilian Regional Centre for the Spontaneous Reporting of Adverse Drug Reactions (ADRs) during the period from 1996 to 2006, with the aim to identify their most important features. One hundred ADR reports out of 3471 involved CM (2.9%); 29 reports were serious, including 1 fatal case. Skin, respiratory system and gastrointestinal tract were most frequently affected sites. The majority of reports described hypersensitivity reactions with immediate onset. Iopromide (52.5%), iopamidol (13.9%) and iomeprol (11.9%) were the drugs with the highest number of reports. Case reports collected by the Sicilian Regional Centre showed that CM adverse reactions are not common or not commonly signalled; however, in agreement with previous published reports, analysis of data suggests that they are generally allergic-like reactions. Further investigations are needed within post-marketing surveillance to identify and prevent the consequences of CM adverse reactions and interactions. Awareness about CM safety should be promoted among all healthcare professionals.

冠動脈造影後に生じる副作用に関する調査

We investigated 468 inpatients for adverse reactions occurring after they underwent coronary angiography (CAG) according to the specified clinical path in the cardiology department of our hospital. Upon interviewing the patients we noted that about 20% of them had symptoms like headache, nausea, vomiting, and giddiness.Though such symptoms were more prevalent in women and patients who had a history of allergic reactions to medicines, no correlation was found between symptom occurrence rates and age, type of contrast media used or dosage. These adverse effects occurred one hour or more after undergoing CAG. The rate of occurrence for such delayed reactions was 37 % in the patients in whom they were observed and 7.6% for all patients. Although these adverse effects were assumed to be mainly due to contrast media, the possibility of them being due to other drugs could be not be ruled out. However, symptoms were very similar to those for delayed adverse reactions of contrast media reported in the past.Unexpected adverse reactions due to contrast media will continue to occur and may be serious so patients should be carefully observed following CAG.

造影剤の副作用発現に及ぼすＤｏｍｐｅｒｉｄｏｎｅ，Ｅｔｉｚｏｌａｍおよび電解質補液の予防効果

Our previous studies suggested that menopause and a preexisting abnormal renal function may be risk factors leading to an increased occurrence of adverse reactions to contrast media. The present prospective clinical study was carried out to examine the effect of pretreatment with domperidone, etizolam and fluid replacement on a reduction of adverse reactions induced by contrast media in patients with these risk factors.In 3009 patients undergoing a coronary angiography examination, a randomized and controlled trial was conducted from April 1, 1998 to March 31, 2000. Perimenopausal patients (n=732) were divided into two groups including: a post menopause group within 5 years (n=265) and over 5 years (n=467). Next, these two groups were further individually classified into two groups including: a domperidone and etizolam pretreated patient group (within 5 years; 132 patients, over 5 years; 233 patients) and a non-treated patient group (within 5 years; 133 patients, over 5 years; 234 patients). In addition, patients (n=83) with an abnormal renal function (serum creatinine level of 1.5 mg/mL or greater) were also divided into a pretreatment with fluid replacement group (42 patients) and a non-treatment group (41 patients).The overall incidence of adverse reactions of contrast media was 11.2%, and there were no serve or fatal adverse reactions. In female patients, the predominant adverse reactions included headache, vomiting, dizziness, glow and palpitations. Pretreatment with a combination of domperidone and etizolam suppressed the adverse reactions due to contrast media by 77% in post menopausal patients within five years. On the other hand, in postmenopausal patients (n=467) over five years, the pretreatment (n=233) did not effectively reduce the side effects of contrast media. In addition, in patients with an abnormal renal function, the incidence (16.7%) of adverse reactions in fluid replacement pretreatment-patients was significantly less than that (51.2%) in the non-treated patients.These results indicate that the pretreatment of patients with domperidone, etizolam and fluid replacement was found to successfully reduce the incidence of adverse reactions induced by contract media in patients with risk factors such as menopause and a preexisting abnormal renal function, respectively.

Problems in surveying the incidence of delayed adverse reactions to contrast media

The purpose of the study was to investigate the frequency and causative factors of symptoms unrelated to contrast media among patients who were evaluated as having late adverse reactions to non-ionic contrast media. The symptoms in both the enhanced and plain computed tomography (CT) groups were analysed. In this study the criteria for late adverse reactions were: (1) the patient had never experienced the symptoms before; (2) the symptoms had no relation to medications or orally ingested substances; (3) the symptoms occurred 1-24 h after CT scanning. Two hundred outpatients received contrast (a non-ionic, monomeric contrast media 320 mg I/ml)-enhanced CT scans and a further 200 received plain CT scans. After the CT scans were performed the patients were asked to fill out a questionnaire: 137 (68.5 %) patients in the contrast-enhanced CT group and 116 (58.0 %) in the plain CT group responded. The incidence of late adverse reactions was 7.3 % among those who responded in the contrast-enhanced CT group (Table 1) and 2.6 % among those who responded in the plain CT group, which were qualified as false late adverse reactions (Table2). The adverse events in cases 9 and 10 of Table 1 and in cases 2 and 3 of Table 2 could have been influenced by the simultaneous presence of influenza. Delayed symptoms due to factors other than contrast media include symptoms due to underlying diseases and

Contrast Media Adverse Reactions

Contrast Media Adverse Reactions

Contrast media adverse reactions: occurrence, recurrence, and distribution patterns.

The second phase of the survey of adverse reactions to contrast media was based on 4,120 case reports and involved the collaboration of radiologists in 45 institutions. It was directed primarily to a study of the distribution patterns of adverse reactions and the likelihood of recurrence of the same reaction on repetition of the examination. It was found that major life-threatening reactions involving the respiratory system are usually accompanied by minor or less serious reactions, while those involving the cardiovascular system are accompanied by the more serious reactions. Major life-threatening reactions do not usually recur on reexamination, while minor reactions tend to be repeated more often.