Iodine Allergy Research Articles

Improving povidone-iodine and iodine preparations for patch testing.

Allergy evaluation by patch testing with povidone-iodine (PVP-I) or iodine remains challenging, because current patch test preparations frequently lead to false-positive or irritant skin reactions. To investigate different preparations for iodine patch tests and to assess their clinical relevance with repeated open application tests (ROATs). We monocentrically analyzed 95 patients with suspected allergy to disinfectants in retrospect who underwent parallel iodine patch testing with four preparations: PVP-I 2% aq., 5% aq., 10% aq., and iodine 0.5% pet. In 27 of 95 patients (28.4%), we found positive reactions to one of the four test preparations. After ROATs in 22 of these 27 positively tested individuals, only one patient was diagnosed with iodine allergy. In contrast, 31 of 95 patients (32.6%) showed irritant or questionable patch test reactions on day 2 (D2) and/or D3 and/or D7 to one or more test preparations. Testing with PVP-I 2% aq. resulted in the lowest number of doubtful skin reactions while detecting the single allergic patient. PVP-I 2% aq. was found to be the optimal patch test preparation. In general, iodine allergy appears to be substantially overestimated, and positive patch test responses to iodine should prompt an urgent ROAT for confirmation before diagnosing iodine allergy.

A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation.

To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation. A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded. Ears were packed using one of two distinct methods. Pack A: gelatin sponge, chloramphenicol ointment and anantibiotic-soaked ear wick. Pack B: antibiotic-soaked gelatin sponge, bismuth iodoform paraffin paste (BIPP) impregnated gauze dressing. The primary outcome measure was post-operative complications associated with each packing method RESULTS: One hundred and fifty-three tympanoplasties were performed during this period: 68 underwent Pack A and 85 underwent Pack B. Chi squared test showed no significant association between pack type and complication rate (p = 0.572). Univariate analysis suggested that age (p = 0.047) and concurrent bony canaloplasty (p = 0.006) significantly increased complication rates. Pre-operative ear status, indication, graft type and gender did not affect complication rate. BIPP-impregnated ribbon gauze and chloramphenicol/wick are both comparable methods for packing an ear following tympanoplasty for tympanic membrane perforation. This is useful information both for surgeons who commonly use BIPP and have a patient with a known iodine allergy, or who is not known to be allergic to iodine but has been packed with BIPP previously, and for those who do not have access to BIPP and wish to use a pack with comparable success.

Absence of Iodinated Contrast Hypersensitivity and Characterization of Gadolinium Utilization in an Interventional Pain Population.

Iodinated contrast media (ICM) allergy labels pose a unique clinical problem for the interventional pain physician due to the drawbacks of gadolinium for enhancement during pain procedures, as well as the reluctance to add to the cumulative steroid burden with steroid premedication. However, the risks of ICM hypersensitivity specific to this setting have not been previously described. We aimed to describe the incidence of ICM-induced hypersensitivity during the performance of epidural injections in a large healthcare system. We also sought to characterize preexisting ICM allergy labels and how these affected consequent gadolinium utilizations in this population. 6,471 epidural pain procedures requiring contrast enhancement were performed during the 18-month study period. There were no reported contrast-induced hypersensitivity reactions in this time. 108 patients (1.6%) had a preexisting ICM allergy; a shellfish/seafood allergy was recorded in 118 patients (1.82%), and 51 charts (0.78%) were labeled with "iodine" allergy. 183 individuals received gadolinium for enhancement during epidural steroid injections. 96.7% of gadolinium utilization occurred in the context of preexisting allergy labels in the electronic medical record. Of note, 20 patients (18.5%) with ICM allergy labels also received iodinated contrast, and this was uneventful in all cases. Our results suggest that ICM-associated hypersensitivity is very rare during epidural procedures and the incidence is significantly lower than expected based on reaction rates during intravascular administration. This may be related to both dose as well as route of administration. The establishment of a protocol for safe workup of ICM allergy labels would be useful in optimizing pain procedures.

ヨードアレルギーのため診断・治療手段を制限されたhemosuccus pancreaticusの1例

ヨードアレルギーのため診断・治療手段を制限されたhemosuccus pancreaticusの1例

Intraocular surgery endophthalmitis prophylaxis with self-reported iodine allergy.

Intraocular surgery endophthalmitis prophylaxis with self-reported iodine allergy.

4:21 PM Abstract No. 136 Use of contrast-enhanced ultrasound after computed tomography–guided microwave ablation for hepatocellular carcinoma in our practice with magnetic resonance imaging and pathologic correlation

Contrast-enhanced ultrasound (CEUS) is a low cost and effective imaging modality that is accessible immediately post procedure which allows the clinician to instantly perform additional ablation of the tumor if a residual tumor is detected. CEUS can be an alternative to contrast enhanced CT in patients with underlying renal disease or iodine allergy. The purpose of this abstract is to share our experience with use of contrast enhanced ultrasound after microwave ablation for HCC with MRI correlation and posttransplant pathology. This is a retrospective analysis of 13 patients in an IRB-approved study conducted at our institution from 2017-2019. The patients were identified during liver tumor board with diagnosis of hepatocellular carcinoma (HCC) amenable to microwave ablation. These patients underwent CT-guided microwave ablation of HCC. Immediately post procedure patients underwent CEUS to evaluate for residual tumor, which was reported by an expert ultrasound radiologist providing us with instant feedback regarding residual tumor. Patients underwent MRI one month post procedure to evaluate for residual tumor within the treatment bed. Pathology reports were obtained for the patients that received liver transplants and radiologic and pathologic correlation was made to the treatment site. 7 postablation CEUS examinations demonstrated complete response to therapy with concordant results on follow-up MRI. 3 went on to have a liver transplant with complete or near complete response. Four post ablation CEUS examinations were read as suboptimal. Follow-up MRI for 3 showed complete response and 1 showed viable tumor in the treatment cavity. 1 patient had transplant before MRI. Transplant pathology showed complete response. Out of 13 patients 1 study was discordant with no enhancement seen on CEUS at the time of ablation with viable tumor on MRI. See Table 1. Preliminary data demonstrates congruence between post ablation CEUS and follow-up MRI or CEUS with no residual tumor in the treatment bed in 7 of 13 of our patients. Artifact and operator dependence can limit evaluation however CEUS is still an inexpensive and useful tool post ablation.Table 1Summary of Patients with Postablation CEUS and MRI13 Patients7 patients: concordant CEUS and MRI complete response3 patients transplanted2 pathology reports with complete response; 1 with partial response4 patients: postablation CEUS suboptimal because of artifact3 compete response; 1 viable tumor1 transplant with complete response1 patient: CEUS no MRI because of transplantPathology report shows complete response1 patient: discordant CEUS and MRI Open table in a new tab

Does an Antimicrobial Incision Drape Prevent Intraoperative Contamination? A Randomized Controlled Trial of 1187 Patients

The risk of periprosthetic joint infection (PJI), a serious complication after arthroplasty, has not changed for years. Interventions such as eradication of Staphylococcus aureus and antibiotic bone cement are used to diminish infection risk but despite these efforts, the percentage of infection in TKA remains constant. Antimicrobial drapes have a dual action, acting both as a physical and antimicrobial barrier to counter bacterial contamination of the surgical wound. To study the effect of antimicrobial drapes, we used intraoperative contamination as a proxy for infection in our investigation. (1) Do antimicrobial surgical drapes reduce the risk of intraoperative microbial contamination in patients undergoing primary knee arthroplasty? (2) Are other factors such as sex, season, age, type of arthroplasty and duration of surgery associated with an increased risk of contamination in patients undergoing primary knee arthroplasty? (3) Does loosening of the antimicrobial drape increase contamination risk? An investigator-initiated, two-arm, non-blinded, multicenter, randomized, controlled trial was performed at five different hospitals in the capital and central regions of Denmark. Twenty-four surgeons participated in the study. Participants were patients older than 18 years undergoing primary knee arthroplasty. We excluded patients with an iodine allergy, previous open knee surgery, previous septic arthritis, any antibiotics taken 4 weeks before surgery, and if they were unable to understand the implications of study participation. Patients were randomly assigned to operation with an antimicrobial drape (intervention group) or operation without (control group). We screened 1769 patients, of which 100 were ineligible and 10 declined to participate. In all, 94% (1659 of 1769) of patients consented and were randomized to the intervention group (51%, 838 of 1659) and control group (49%, 821 of 1659), respectively. In all, 36% (603 of 1659) of patients in the intervention group and 35% (584 of 1659) patients in the control group were available for final analysis. No crossover was performed, and analysis was done per-protocol. Patients were excluded due to logistic failures like lack of utensils, samples disappearing en route to the laboratory mainly caused by implementation of a new electronic patient chart (EPIC, Verona, WI, USA), and forgetful surgeons. Intraoperatively, we swabbed for bacteria at the surgical site and in a rinse from the surgeons' gloves. All samples were sent for cultivation, and colony forming units (CFUs) counts ≥ 1 were deemed contaminated. The primary outcome measure was the difference in the proportion of contaminated patients between the two randomized groups. Secondary outcome measures were the affiliation of sex, season, age, type of implant used, and duration of surgery on contamination risk. To investigate whether other factors were affiliated with contamination risk, we did a logistic regression to control for confounding variables, including sex, age, season, type of implant and duration of surgery. Use of iodinated drapes reduced contamination, with contamination detected in 10% (60 of 603) procedures where iodinated drapes were used compared with 15% (90 of 584) when they were not (odds ratio 0.61 [95% CI 0.43 to 0.87]; p = 0.005), with a relative risk reduction of 35% (95% CI 12.3 to 52.5) and a number needed to treat of 18 patients. After controlling for confounding variables such as sex, age, type of implant, and duration of surgery, we found that not using an antimicrobial drape increased contamination risk by a factor of 1.6 (95% CI 1.08 to 2.35; p = 0.02). Female sex and undergoing surgery in the central region were associated with lower odds of contamination (OR 0.55 [95% CI 0.39 to 0.8]; p = 0.002 and OR 0.45 [95% CI 0.25 to 0.8]; p = 0.006, respectively). Patients with more than a 10-mm separation of the drape from the skin had higher odds of contamination (OR 3.54 [95% CI 1.64 to 11.05]; p = 0.0013). The use of an antimicrobial drape resulted in lower contamination risk than operating without an antimicrobial drape. Our findings suggest that antimicrobial drapes are useful in infection prevention, but further studies are needed to investigate the effect of antimicrobial drapes on infection. Level I, therapeutic study.

Digital Variance Angiography as a Risk Reduction Measure in Peripheral Endovascular Interventions

Introduction: Digital Variance Angiography (DVA) - that is based on the kinetic imaging technology - is a novel, patented X-ray image processing method visualizing contrast motion by calculating the variance of each pixel intensity in a recorded series of images. The image processing algorithm is built in a software that is able to generate DVA images from raw X-ray image series. Our aim was to determine the potential benefits of DVA in peripheral endovascular interventions. Methods: Two observational studies enrolled 66 patients undergoing lower limb X-ray angiography due to symptomatic peripheral arterial disease. A subgroup of 24 patients received carbon-dioxide (CO2) as contrast medium. We compared the signal-to-noise ratios (SNRs) of Digital Subtraction Angiography (DSA) and DVA image pairs. Visual quality comparisons were also performed by vascular specialists using an online questionnaire. Interrater agreement was characterized by percent agreement and Fleiss' kappa. Results: A total of 6814 regions of interest were selected on image pairs to calculate and compare SNRs. The ratio of SNR(DVA)/SNR(DSA) was calculated. DVA provided 3.3 times (median) higher SNR than DSA on angiograms obtained using iodinated contrast medium (ICM). The ratio was 3.0 times (median) higher in the images of the CO2 subgroup. In 69% of the ICM group comparisons it was judged that DVA provided higher quality images than DSA. Fleiss's kappa was 0.17 (p< 0.001). DVA was preferred over DSA in 85% of paired image comparisons in the CO2 subgroup. Fleiss's kappa was 0.27 (p< 0.001). Conclusion: In conclusion, DVA provides significantly higher image quality than the current reference standard DSA while performing catheter angiography with ICM or CO2. The higher image quality makes CO2 angiography more feasible for patients with renal insufficiency and iodine allergy. The significant SNR difference suggests a remarkable reduction of radiation and ICM exposure, thus ongoing studies are investigating the optimal protocols for low-dose DVA acquisition. Disclosure: The studies were supported by Kinepict Health Ltd

562. Reducing MRSA Bacteremia in Adult Patients through MRSA Decolonization Bundle

BackgroundPatients colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at an increased risk of developing a subsequent MRSA infection. Moreover, these individuals may serve as an endogenous reservoir to spread the bacteria to other patients. In an attempt to reduce MRSA bacteremia rates, a decolonization protocol was developed and implemented at a tertiary teaching hospital in Detroit, Michigan. In this study, we evaluate the intervention’s impact on community-onset (CO) and hospital onset (HO) MRSA bacteremia rates.MethodsInfection Control developed an MRSA decolonization bundle for adults that consisted of daily Chlorhexidine gluconate (CHG) bathing and twice-daily nasal swabs with 10% Povidone–iodine (PI) or Nozin for individuals with iodine allergies. Patients with known risk factors for developing an MRSA infection, such as patients residing in an intensive care unit and/or undergoing specified procedure, were prescribed the bundle for their length of stay (Figure 1). Countraindications for nasal decolonization included inhalation injuries, CSF leaks, ENT surgeries, and transphenoidal surgeries. A retrospective chart review of high-risk patients was conducted to determine compliance with the elements of the MRSA decolonization bundle. Rates of CO and HO MRSA bacteremia per 1,000 patient-days were graphed against compliance with bundle elements (2 nasal swabs and 1 CHG bath per day). To quantify the correlation, a linear regression model and the Pearson coefficient was used.ResultsApproximately 2,000 and 1,000 opportunities for nasal decolonization and CHG bathing, respectively, were identified between September 2018 and March 2019. The data suggest a strong correlation between compliance with MRSA decolonization elements and rate of HO MRSA bacteremia (R2 = 0.785) and a moderate association between nasal decolonization and rate of CO bacteremia (R2 = 0.322) (Figures 2 and 3).ConclusionThe MRSA decolonization bundle of CHG bathing and nasal swabs appears to be an effective strategy to decrease HO MRSA bacteremia rates with higher bundle compliance being associated with lower rates of infection. Disclosures All authors: No reported disclosures.

BET 2: Is there an association between iodine, shellfish and contrast agent allergies?

A shortcut review was carried out to establish whether having a shellfish or iodine allergy changed the risk of allergic reaction in patients receiving radiocontrast medium more than other concomitant...

Radiocontrast Media Hypersensitivity: Skin Testing Differentiates Allergy From Nonallergic Reactions and Identifies a Safe Alternative as Proven by Intravenous Provocation

Hypersensitivity reactions occurring within minutes after intravascular injection of iodinated radiocontrast media (RCM) are not rare and have been previously considered to be nonallergic. However, in the last decades, evidence is increasing that genuine RCM allergy may present as either full-blown anaphylaxis or delayed exanthematous skin reaction. We aimed to assess whether allergy diagnostics including skin and provocation testing can differentiate between nonallergic and allergic RCM hypersensitivity by identifying the causative RCM as well as tolerated alternative RCM. We retrospectively evaluated clinical and diagnostic data from 45 consecutive patients with RCM hypersensitivity. Immediate nonallergic RCM hypersensitivity was diagnosed in 21 patients, immediate-type RCM allergy in 11, delayed-type RCM allergy in 11, and delayed-type iodine allergy in 2. All patients with immediate-type RCM allergy had a history of moderate to severe anaphylaxis. Eleven of 13 patients with delayed-type allergic reactions including the 2 cases of iodine allergy suffered from maculopapular exanthem developing several hours to days after exposure, 1 was a systemic hypersensitivity syndrome, and 1 a fixed drug eruption. Of 18 RCM-allergic patients tested, all tolerated an alternative RCM in the intravenous provocation. The diagnostic sensitivity of intradermal RCM testing to identify allergic patients is high in both immediate-type and delayed-type RCM allergy. Intravenous provocation with a skin test-negative RCM is safe and enables identification of a tolerated alternative RCM. Additional skin testing of iodine solution is required to identify patients with iodine allergy.

The Iodine allergy myth: What is contraindicated and alternative options for retrograde pyelography

The Iodine allergy myth: What is contraindicated and alternative options for retrograde pyelography

Diagnostic value of magnifying endoscopy with blue laser imaging for early esophageal cancers

Objective To evaluate the magnifying endoscopy with blue laser imaging(M-BLI) for early esophageal cancers. Methods A total of 153 focal esophageal lesions detected with conventional white light endoscopy (WLE) based on changes of mucosal shape and color were enrolled in this study. Patients were examined with WLE, M-BLI, and 1.25% Lugol′s iodine chromoendoscopy between April 2015 and December 2016. Diagnostic consistency of M-BLI and Lugol′s iodine chromoendoscopy were evaluated with pathology as a golden standard. Results Pathological diagnosis showed there were 19 lesions of esophagitis or chronic mucosal inflammation, 92 of low grade intraepithelial neoplasia, and 42 high grade intraepithelial neoplasia or early cancer. Diagnostic sensitivities of WLE, M-BLI and Lugol′s iodine chromoendoscopy of screening early cancer were 66.7%(28/42), 95.2%(40/42), and 95.2%(40/42) respectively, the specificities were 57.7%(64/111), 91.9%(102/111), and 92.8%(103/111) respectively. The consistency rate between endoscopy and pathological examination were 60.1%(92/153), 92.8%(142/153), and 93.5%(143/153)respectively, and the Kappa values were 0.565, 0.891, and 0.906 respectively. The detection rate of M-BLI was higher than that of WLE alone (χ2=9.166, P=0.002). Conclusion The diagnostic value of M-BLI for early esophageal cancer is similar to that of Lugol′s iodine chromoendoscopy. However, M-BLI is easier to operate, and superior to Lugol′s iodine staining endoscopy in the absence of iodine allergy, long operating time and patients′ intolerance. Key words: Diagnosis; Esophageal neoplasms; Blue laser imaging; Magnifying endoscopy

Multiple cutaneous metastases as the first sign of metastatic carcinoma of unknown primary

An elderly man with a background of bladder cancer in remission, monoclonal gammopathy of uncertain significance and chronic obstructive pulmonary disease was referred by his general practitioner to the dermatology...

Current Epidemiology and Management of Radiocontrast-Associated Acute- and Delayed-Onset Hypersensitivity: A Review of the Literature.

Radiocontrast-associated acute-onset hypersensitivity reactions now occur less frequently than before 1990, when high-osmolar, ionic, radiocontrast agents were widely used. Premedication with corticosteroids and antihistamines does not reliably prevent recurrent low-osmolar radiocontrast-associated acute hypersensitivity reactions. Corticosteroid prophylaxis for acute hypersensitivity currently causes more morbidity than benefit. The specific radiocontrast agent that is associated with a patient's adverse reaction must be displayed in the drug intolerance or drug "allergy" field of their electronic health record to enable effective management and prevention of future reactions. The term iodine allergy should never be used in the context of radiocontrast-associated adverse reactions because it leads to poorer clinical outcomes. The time to onset of the reaction and the nature of the reaction must be noted in enough detail in the drug intolerance comment fields in the electronic health record to determine the potential mechanism for the reaction and to enable selection of the appropriate radiocontrast material for future exposures. Most individuals with a history of radiocontrast agent hypersensitivity can be effectively managed by selecting an alternative radiocontrast agent, without any premedication. Radiology Departments, catheterization laboratories, and all physicians who use parenteral radiocontrast media must have management plans in place to treat severe acute reactions when they occur. Patients should be informed that delayed-onset reactions, mostly benign rashes within one week of exposure, are as common or more common than acute reactions. Future radiocontrast-associated acute and delayed-onset reactions can be minimized, but never completely avoided, by using an appropriate alternative agent.

The Effect of Dextrose Instillation on a Man with Chylous Hematuria

Chyluria is a morbid condition and sclerotherapy is a minimally invasive treatment modality in treatment of chyluria. The benefit of sclerosing agents have been analyzed in previous studies; however, our patient has iodine allergy and silver nitrate is not available at our institution. So we chose 50% dextrose as sclerosing agents. We found that chyluria was cured without any complication. This result might offers a simple and safe modality of treatment.

184 Can Adjunct Use of Topical Provodine® Improve Healing Rates in Patients With Skin Abscesses?

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an important cause of skin abscesses in patients seen in emergency departments. Provodine® is a topical povidone-iodine broad-spectrum antiseptic. The potential benefit of Provodine® for patients with a drained abscess is unclear. Our objectives were to determine if the addition of Provodine® would be superior to standard treatment in patients who had an abscess that was treated with incision and drainage (I&D). The primary outcome was clinical cure 7-10 days after I&D. The secondary outcomes were rate of development of new skin lesions and spread in household contacts (HC) within 30 days. This is a randomized controlled pilot study of a convenience sample of 100 adult patients presenting with an abscess requiring I&D. Patients were excluded if they were unable to provide informed consent, were homeless or incarcerated, had active IV drug use or iodine allergy, had an abscess on the face or breast, or required admission or surgical drainage. Patients were randomized to Provodine® or standard care. All patients had I&D and packing of the abscess and wound cultures sent. Patients randomized to Provodine® had the agent applied with a Q-tip to the abscess cavity and surrounding skin after I&D. Patients were instructed to leave packing in place and change the dressing daily until the first wound check. Subjects returned at 48-72 hours. All patients were instructed on daily dressing changes with gauze. Patients randomized to Provodine® were instructed to wash hands with Provodine® and apply the agent to the cavity and skin daily. Patients randomized to standard care were instructed to wash hands daily with soap and water. All patients were advised to continue daily wound care until the second wound check or until cavity had closed. Subjects returned at 7-10 days. They were also contacted by telephone for data collection at 30 days. Compliance with intervention and side effects were recorded. Additional interventions for patients not clinically improving or worsening were considered treatment failures. Data was collected including clinical cure, new lesion development, and spread to HC at each visit and at 30 days. The mean age of patients was 41.73 years (range, 19 to 74). Thirty-seven percent of cultures were positive for MRSA. Clinical cure at 7-10 days occurred in 42 of 46 patients (91.3%) in the standard group versus 45 of 51 patients (88.2%) in the Provodine® group (difference, 3.1 percentage points; 95% confidence interval [CI], 0.19 to 2.71; p=0.744). Spread to HC within 30 days occurred in 4 of 39 patients (10.26%) in the standard group versus 2 of 39 patients (5.13%) in the Provodine® group (difference, 5.13 percentage points; 95% confidence interval [CI], 0.36 to 12.28; p=0.675). Development of a new lesion within 30 days occurred in 8 of 41 patients (19.51%) in the standard group versus 8 of 39 patients (20.51%) in the Provodine® group (difference, 1.0 percentage points; 95% confidence interval [CI], 0.31 to 2.81; p=1). The addition of Provodine® to standard treatment did not improve clinical cure, rate of new lesion development, or spread to HC in patients with cutaneous abscesses requiring incision and drainage.

Iodinated Contrast Media and the Alleged "Iodine Allergy": An Inexact Diagnosis Leading to Inferior Radiologic Management and Adverse Drug Reactions.

Purpose To test the hypothesis that the incomplete diagnosis "iodine allergy" is a possibly dangerous concept for patients under routine radiologic conditions. Materials and Methods 300 patients with a history of an "iodine allergy" were retrospectively screened and compared with two age-, sex-, and procedure-matched groups of patients either diagnosed with a nonspecific "iodine contrast medium (ICM) allergy" or an allergy to a specific ICM agent. For all groups, the clinical symptoms of the most recent past adverse drug reaction (ADR), prophylactic actions taken for subsequent imaging, and ultimate outcome were recorded and analyzed. Results The diagnosis "iodine allergy" was not otherwise specified in 84.3 % patients. For this group, in most cases, the symptoms of the previous ADRs were not documented. In contrast, the type of ADR was undocumented in only a minority of patients in the comparison groups. In the group of patients with an "iodine allergy" the percentage of unenhanced CT scans was greater than within the other two groups (36.7 % vs. 28.7 %/18.6 %). ADRs following prophylactic measures were only observed in the "iodine allergy" group (OR of 9.2495 % CI 1.16 - 73.45; p < 0.04). Conclusion This data confirms the hypothesis that the diagnosis "iodine allergy" is potentially dangerous and results in uncertainty in clinical management and sometimes even ineffective prophylactic measures. Key points · The term "iodine allergy" is imprecise, because it designates allergies against different substance classes, such as disinfectants with complexed iodine and contrast media containing covalently bound iodine.. · There is a clear correlation between the exactness of the diagnosis - from the alleged "iodine allergy" to "contrast media allergy" to naming the exact culprit CM - and the quality of documentation of the symptoms.. · Management of patients diagnosed with "iodine allergy" was associated with uncertainty leading to unenhanced scans and sometimes unnecessary prophylactic actions.. · The term "iodine allergy" should be omitted, because it is potentially dangerous and can decrease the quality of radiology exams.. Citation Format · Böhm Ingrid, Nairz Knud, Morelli John N et al. Iodinated Contrast Media and the Alleged "Iodine Allergy": An Inexact Diagnosis Leading to Inferior Radiologic Management and Adverse Drug Reactions. Fortschr Röntgenstr 2017; 189: 326 - 332.

Mono-Energy Coronary Angiography with a Compact Synchrotron Source

X-ray coronary angiography is an invaluable tool for the diagnosis of coronary artery disease. However, the use of iodine-based contrast media can be contraindicated for patients who present with chronic renal insufficiency or with severe iodine allergy. These patients could benefit from a reduced contrast agent concentration, possibly achieved through application of a mono-energetic x-ray beam. While large-scale synchrotrons are impractical for daily clinical use, the technology of compact synchrotron sources strongly advanced during the last decade. Here we present a quantitative analysis of the benefits a compact synchrotron source can offer in coronary angiography. Simulated projection data from quasi-mono-energetic and conventional x-ray tube spectra is used for a CNR comparison. Results show that compact synchrotron spectra would allow for a significant reduction of contrast media. Experimentally, we demonstrate the feasibility of coronary angiography at the Munich Compact Light Source, the first commercial installation of a compact synchrotron source.

造影剤アレルギーを有する脳血管障害患者に対する直達手術

造影剤アレルギーを有する脳血管障害患者に対する直達手術