In recent years a great deal of interest has been focused on the anaphylactoid reactions produced by organic iodide contrast media. One aspect of this problem has been the feasibility of employing premedication to prevent such occurrences. Antihistamines have been rather widely administered for this purpose, although evidence indicates that their effectiveness has not fulfilled expectations. As an example, in 1958 Finby, Evans, and Steinberg (1) found that antihistamines were unsuccessful in preventing major reactions, whether given orally or intravenously. They concluded that the antihistamines were useful in therapy, but not in prophylaxis. Because some radiologists mix the antihistamines in the same syringe employed for the contrast medium, this study was undertaken to determine whether any pharmacological incompatibility develops. An analysis of these reactions is one objective of this communication. Another possibility is that of pharmacological incompatibility between the plastic disposable syringes now available and the contrast agent. If one judges from the lack of material in the literature, this question is of such recent origin as to have been insufficiently investigated. In view of the separate nature of these two aspects of contrast medium reactions, the purpose of our investigation was necessarily twofold. First, we attempted to determine whether a mixture of antihistamines and contrast media would produce any pharmacologically undesirable reactions. Secondly, we attempted to determine whether any of the presently used contrast agents would prove pharmacologically incompatible with Stylex polystyrene disposable syringes manufactured by Pharmaseal Laboratories, Inc. Methods of Investigation For investigating the reactions that occur when contrast media are mixed with antihistamines, serology tubes were employed to simulate glass syringes or any other glass vessel in which the agents might be mixed. The contrast medium was added to the antihistamine in varying amounts to produce varying dilutions of the mixture. We selected dilutions of 40:1, 20:1, 10:1, 5:1, 2:1, and 1:1 for each combination of contrast medium and antihistamine, respectively. The additions were performed with a syringe, always with the same size needle (18 gauge) to ensure drops of a constant size. The reactions were studied and noted at three different times:(a) immediately upon mixing;(b) one hour after mixing; and (c) forty-eight hours after mixing. A positive reaction was interpreted as one which produced any kind of precipitate or flocculation, considered evidence of incompatibility between the two agents. In all cases in which paradoxical or inconsistent results were obtained, the experiment was repeated until the investigators were satisfied that the initial result was either definitely valid or definitely incorrect. Eight contrast media and six antihistamines were studied by this method. Each antihistamine was mixed with all the contrast media. The contrast media employed were as follows: Diodrast, Conray 60 per cent, Angioconray 80 per cent, Cholografin, Hypaque 75 per cent, Reno-grafin 60 per cent, Renovist, and MP-271 (2). The antihistamines were Benadryl, Phenergan, Dramamine, Dimetane, Wydase, and Chlor-Trimeton. Another method was utilized for investigating the possibility of pharmacological incompatibility between contrast media and polystyrene disposable syringes. This method was a duplication of that followed by Pharmaseal Laboratories and Mallin-ckrodt Pharmaceuticals in their original investigation of this problem (3, 4). Two samples of each contrast medium to be tested were placed in Stylex polystyrene syringes, one at 25°C, the other at 37°C. The resulting systems were examined visually and spectrophotometrically each day for five days. If no degeneration, destruction, or clouding of the syringe were detected, and if there were no changes in the contrast medium, the system was considered completely compatible. Fourteen widely used contrast media were examined in this manner.
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