Severe Anaphylactoid Reactions Research Articles

Anaphylactoid Reactions Associated with Ondansetron

To describe two patients with anaphylactoid-type reactions to ondansetron. A 41-year-old man with grade III leiomyosarcoma of the right tibia was admitted to the hospital for his second dose of first-cycle neoadjuvant intraaterial cisplatin 60 mg/m2 therapy. He experienced an anaphylactoid reaction following intravenous ondansetron infusion that was confirmed on rechallenge. In a second case, premedication with intravenous ondansetron resulted in an anaphylactoid reaction in a 44-year-old woman with stage III ovarian cancer receiving her ninth course of cyclophosphamide and carboplatin. Both patients had received ondansetron previously with no adverse effects. Peer-reviewed journal articles and reports, obtained through a MEDLINE search, were reviewed. Information on the individual cases was obtained from the patients' medical records. Preservative changes in ondansetron infusion were examined as possible causes of the anaphylactoid reactions in our patients, but no conclusive data linking them were found. The efficacy and safety of ondansetron has led to the widespread use of this medication in the treatment of nausea and vomiting caused by cancer chemotherapy and radiation therapy. Practitioners should be made aware that acute severe anaphylactoid reactions could occur in patients who have previously received ondansetron with no adverse effects.

A severe anaphylactoid reaction during Cascade Filtration in a patient receiving ACE inhibitors

We report a case of severe anaphylactoid reaction in a patient during the first treatment with Cascade Filtration (CF), utilizing a cellulose-diacetate hollow-fiber filter. Similar reactions were not seen in another seven patients with the same medical pathology (Essential Mixed Cryoglobulinemia Type 2 with monoclonal IgM), who also underwent treatment with CF but did not receive ACE inhibitors. The anaphylactoid reaction (IgE independent) could be due to an accumulation of bradykinin caused by blockage of catabolism by ACE inhibitor and by increased and rapid synthesis following contact with inert materials (cellulose diacetate).

Elevated Risk of Anaphylactoid Reaction From Radiographic Contrast Media Is Associated With Both ß-Blocker Exposure and Cardiovascular Disorders

A case-control study, with both retrospective and concurrent subject selection, was performed (1) to determine whether greater risk for anaphylactoid reaction from contrast media associated with beta-blocker exposure reflects presence, or is independent of underlying cardiovascular disorder; and (2) to characterize further the risk of anaphylactoid reaction from contrast media in patients with cardiovascular disorders and patients with asthma. Adverse reactions from intravenous contrast media were recorded in accordance with quality assurance guidelines. Anaphylactoid reactions were classified as mild to moderate (urticaria/angioedema), severe (stridor, bronchospasm, or hypotension), or major and life-threatening (hypotension with or without the need for subsequent hospitalization). Medical records from reactors were compared with those from matched (gender, age, date, and type of contrast study) controls who received conventional contrast media without adverse reaction. Of 34,371 intravenous contrast media procedures performed, 122 anaphylactoid reactions were recorded. The risk of anaphylactoid reaction was significantly associated with asthma (odds ratio [OR], 8.74; 95% confidence interval [CI], 2.36 to 32.35; P = .0012). The risk of bronchospasm was associated with beta-blocker exposure (OR, 3.73; 95% CI, 1.18 to 11.75; P = .025) and with asthma (OR, 16.39; 95% CI, 4.30 to 62.46; P = .0001). The risk of major and life-threatening reaction was associated with the presence of cardiovascular disorder (OR, 7.71; 95% CI, 1.04 to 57.23; P = .046). Among patients with severe reactions, the risk of hospitalization was elevated by the presence of cardiovascular disorder (P = .001), exposure to beta-blockers (OR, 7.67; 95% CI, 1.79 to 32.85; P = .029), or asthma (OR, 20.7; 95% CI, 1.21 to 355.55; P = .065). Although beta-blocker exposure and the presence of cardiovascular disorder were highly associated (chi 2 = 49, P < .001), a greater risk of bronchospasm with severe reaction was observed in nonasthmatic patients with cardiovascular disorders receiving beta-blockers (OR, 15.75; P = .023). Among reactors with asthma, receiving beta-blockers, or with a cardiovascular disorder, 60.8% (31/51) experienced severe anaphylactoid reactions, compared with 35.2% (25/71) of patients without these risk factors (OR, 3.62; P = .005). beta-Blocker exposure and cardiovascular disorder are both statistically significant risk factors for severe anaphylactoid reaction from contrast media. Thus, patients receiving beta-adrenergic blockers and patients with asthma, on the basis of greater risk for bronchospasm, and patients with cardiovascular disorders, on the basis of elevated risk of major and life-threatening reaction, are appropriate target populations for risk reduction measures before receiving intravenous infusion of contrast media.

Contrast media reactions during voiding cystourethrography or retrograde pyelography

Contrast media can be absorbed across the urothelium in amounts sufficient to cause severe anaphylactoid reactions. We report 2 cases of anaphylactoid reactions during voiding cystourethrography (VCUG) or retrograde pyelography (RGP). A retrospective review of 783 consecutive VCUGs or RGPs performed at our institution over the last five years revealed no other systemic contrast media reactions. Although our findings and a review of the literature discloses that the incidence appears to be extremely low, urologists and radiologists need to be aware that an anaphylactoid or vagal contrast medium reaction may develop during VCUGs or RGPs. In addition, these physicians need to be prepared to treat a reaction should one occur.

Increased Risk for Anaphylactoid Reaction from Contrast Media in Patients on β-Adrenergic Blockers or with Asthma

To determine whether greater risk for anaphylactoid reaction from intravenous urographic contrast media exists in patients receiving beta-adrenergic blockers or in asthmatic patients. Case-control study. Tertiary care, referral-based medical center. Of 28,978 intravenous urographic contrast media procedures done from July 1987 to June 1988, 49 patients experienced moderate to severe anaphylactoid reaction. Medical records from these 49 reactors were compared with those from a control group matched for gender, age, and date and type of contrast study who received intravenous urographic contrast media without adverse reaction. Patients exposed to beta-adrenergic blockers or with asthma comprised 39% (19 of 49) of reactors, compared to 16% (13 of 83) of matched controls (odds ratio, 3.43; 95% CI, 1.45 to 8.15; P = 0.005). Exposure to beta-blockers was 27% among reactors and 12% in matched controls (odds ratio, 2.67; CI, 1.01 to 7.05; P = 0.036). Asthma was found in 12% of reactors and 4% of controls; after correction for beta-blocker use, asthma was also associated with increased risk for anaphylactoid reaction (odds ratio, 4.54; CI, 1.03 to 20.05; P = 0.046). Compared with nonasthmatic patients not taking beta-blockers, asthmatic patients were at greater risk for anaphylactoid reaction with bronchospasm (P = 0.02). Five of 13 reactors receiving beta-blockers became hypotensive, and three needed hospitalization. Compared with nonasthmatic patients not taking beta-blockers, patients exposed to beta-blocking drugs were almost nine times (odds ratio, 8.7; CI, 0.81 to 93.5; P = 0.075) more likely to be hospitalized after an anaphylactoid reaction. Increased risk for moderate to severe anaphylactoid reaction from intravenous urographic contrast media exists in patients receiving beta-adrenergic blockers or with asthma. These patients are appropriate target populations for efforts to reduce risk before intravenous urographic contrast media are administered.

Adverse Effects of Treatment with Porcine Factor VIII

In the last 10 years 63 courses (283 infusions) of porcine FVIII were given to 25 hemophiliacs with high titer alloantibodies and to 5 patients with autoantibodies to factor VIII. Although the product was in general clinically efficacious, adverse effects of treatment were more frequent and severe than previously reported. After 63 courses there was a median percentage fall in baseline platelet count of 54% (range 8-86%); for 10 courses (16%), thrombocytopenia was severe or moderately severe (less than 100 x 10(9)/l), with nadirs of platelet count ranging from 10 to 99 x 10(9)/l (median 67). Allergic reactions were seen in 15 of 30 patients (50%), in 20 of 63 courses (32%), more frequently but not exclusively after the first infusion. Relatively mild symptoms (fever, flushing, urticaria, shivering) occurred in 15 courses; 5 courses, however, were accompanied by more severe anaphylactoid reactions, 2 of which required resuscitation therapy. Allergic reactions were observed both in patients pretreated with steroids or anti-histamines (in 7 of 18 courses, 39%) and in nonpretreated patients (in 13 of 45 courses, 29%). In conclusion, adverse reactions are frequent after porcine FVIII (in 30 of 63 courses, 47%), and can occur also with infusions subsequent to the first. Hence, the recently proposed use of porcine FVIII as home treatment should be implemented with caution.

Severe anaphylactoid reaction to hydroxyethyl starch

A case is presented of a severe anaphylactoid reaction to hydroxyethyl starch solution that occurred peri-operatively and required extended intensive management of the resultant bronchospasm and hypotension. Subsequent intradermal injection of hetastarch produced a delayed positive response, suggestive of a complement-mediated mechanism.

Severe anaphylactoid reaction to Gd-DTPA.

HomeRadiologyVol. 176, No. 3 PreviousNext LettersSevere Anaphylactoid Reaction to Gd-DTPARobert B. LufkinRobert B. LufkinAuthor AffiliationsPresident, Society for Magnetic Resonance Imaging, Department of Radiological Sciences, UCLA Medical Center, 10833 LeConte Avenue, Los Angeles, CA 90024-1721Robert B. LufkinPublished Online:Sep 1 1990https://doi.org/10.1148/radiology.176.3.879-aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Sept 1990 FiguresReferencesRelatedDetailsCited ByAllergy to COVID-19 vaccines: A current updateBeatrizCabanillas, NatalijaNovak2021 | Allergology International, Vol. 70, No. 3Anaphylaxis to trometamol excipient in gadolinium-based contrast agents for clinical imagingJoannaLukawska, DeepalMandaliya, A.W. EdithChan, AmyFoggitt, ThereseBidder, JenniferHarvey, LisaStycharczuk, SotiriosBisdas2019 | The Journal of Allergy and Clinical Immunology: In Practice, Vol. 7, No. 3Safety of approved MR contrast media for intravenous injectionVal M.Runge2000 | Journal of Magnetic Resonance Imaging, Vol. 12, No. 2Neuroimaging Contrast Agents in OphthalmologyAndrew G.Lee, L.AnneHayman, Andrew W.Ross2000 | Survey of Ophthalmology, Vol. 45, No. 3Nephrotoxicity of high-dose gadolinium compared with iodinated contrastMartin R.Prince, ChristinaArnoldus, Joan K.Frisoli1996 | Journal of Magnetic Resonance Imaging, Vol. 6, No. 1Effect of Gd-DTPA and/or Magnetic Field and Radiofrequency Exposure on Sister Chromatid Exchange in Human Peripheral LymphocytesE.Yamazaki, S.Matsubara, I.Yamada1993 | Acta Radiologica, Vol. 34, No. 6Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 176, No. 3 Metrics Altmetric Score PDF download

Severe Anaphylactoid Reaction to Gd-DTPA

HomeRadiologyVol. 176, No. 3 PreviousNext LettersSevere Anaphylactoid Reaction to Gd-DTPARobert B. LufkinRobert B. LufkinAuthor AffiliationsPresident, Society for Magnetic Resonance Imaging, Department of Radiological Sciences, UCLA Medical Center, 10833 LeConte Avenue, Los Angeles, CA 90024-1721Robert B. LufkinPublished Online:Sep 1 1990https://doi.org/10.1148/radiology.176.3.879-aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Sept 1990 FiguresReferencesRelatedDetailsCited ByAllergy to COVID-19 vaccines: A current updateBeatrizCabanillas, NatalijaNovak2021 | Allergology International, Vol. 70, No. 3Anaphylaxis to trometamol excipient in gadolinium-based contrast agents for clinical imagingJoannaLukawska, DeepalMandaliya, A.W. EdithChan, AmyFoggitt, ThereseBidder, JenniferHarvey, LisaStycharczuk, SotiriosBisdas2019 | The Journal of Allergy and Clinical Immunology: In Practice, Vol. 7, No. 3Safety of approved MR contrast media for intravenous injectionVal M.Runge2000 | Journal of Magnetic Resonance Imaging, Vol. 12, No. 2Neuroimaging Contrast Agents in OphthalmologyAndrew G.Lee, L.AnneHayman, Andrew W.Ross2000 | Survey of Ophthalmology, Vol. 45, No. 3Nephrotoxicity of high-dose gadolinium compared with iodinated contrastMartin R.Prince, ChristinaArnoldus, Joan K.Frisoli1996 | Journal of Magnetic Resonance Imaging, Vol. 6, No. 1Effect of Gd-DTPA and/or Magnetic Field and Radiofrequency Exposure on Sister Chromatid Exchange in Human Peripheral LymphocytesE.Yamazaki, S.Matsubara, I.Yamada1993 | Acta Radiologica, Vol. 34, No. 6Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 176, No. 3 Metrics Altmetric Score PDF download

Severe anaphylactoid reaction after IV Gd-DTPA

Serious adverse reactions following the IV administration of Gd-DTPA (Magnevist ®, gadopenetate dimeglumine, Berlex Laboratories, Wayne, NJ), although extremely rare, can occur. As yet, there has been no published case of a severe anaphylactoid-type reaction to Gd-DTPA.

Anaphylactic reactions affecting the human heart

We have investigated a large number of patients, most of whom suffered from severe systemic anaphylactic or anaphylactoid reactions during the induction of anaesthesia; the term 'anaphylactoid' was restricted to patients who had no history of prior exposure. Cardiac dysrhythmia (including severe bradydysrhythmia), which was documented by electrocardiography, was one of the principal manifestations, and in one case there was evidence of myocardial ischemia as well.

Histamine metabolism after adverse reactions due to d-tubocurarine administration.

We investigated histamine release in five female patients, submitted for gynaecological surgery, after intravenous administration of the neuromuscular blocking agent d-tubocurarine. In these patients, we measured the plasma levels of histamine and its metabolites, N tau-methylhistamine and N tau-methylimidazoleacetic acid, making use of mass fragmentographic methods. The newly developed determination of plasma N tau-methylimidazoleacetic acid had a within-day coefficient of variation of 2.7% (n = 10). Normal values of N tau-methylimidazoleacetic acid in plasma ranged from 41.3-75.6 nmol/l (n = 13). All five patients developed anaphylactoid reactions: two patients showed severe systemic reactions, one patient a minor systemic reaction and two had skin reactions only. Plasma histamine and N tau-methylhistamine levels appeared to be the most reliable biochemical parameters for confirming both the occurrence and severity of an anaphylactoid reaction. In comparison with plasma histamine, the determination of plasma N tau-methylhistamine is less hampered by artefacts caused by blood collection and plasma preparation. Together with the fact that the increase in plasma N tau-methylhistamine levels after anaphylactoid reactions lasts much longer than the increase in plasma histamine levels, this leads to the conclusion that the determination of plasma N tau-methylhistamine is a useful retrospective parameter for histamine release in this type of pathological state. The plasma N tau-methylimidazoleacetic acid levels fluctuated considerably, showing only a significant increase after administration of d-tubocurarine in the two patients who had severe anaphylactoid reactions. This parameter is, therefore, less useful in such studies.

Anaphylactoid reaction and non-cardiac pulmonary edema following intravenous contrast injection

A case of severe anaphylactoid reaction following injection of intravenous contrast is described, and a discussion of the treatment of severe allergic reactions follows. The patient's presentation was unusual in that she rapidly developed massive non-cardiac pulmonary edema as the primary symptom, along with hypotension and hypokalemia, a syndrome similar to adult respiratory distress syndrome. The development of the reaction along with the unusual presentation is discussed and a detailed discussion of the generalized treatment of anaphylactoid and anaphylactic reactions is presented. Additionally, several errors in management that may have delayed resolution of the symptoms and prolonged the period of instability in the patient's condition are discussed and critiqued.

Management of Acute Anaphylactoid Reactions

It must be emphasized that successful treatment of a severe anaphylactoid reaction requires rapid diagnosis and initiation of the resuscitation ABC. Intravenous volume infusion and epinephrine are the mainstays of treatment, and antihistamines are useful. Bronchospasm and persistent hypotension will require specific measures, and the overall intensity of treatment needs to be frequently and critically assessed. Identification of the offending drug and appropriate patient follow-up are essential sequelae of successful resuscitation.

ＳＬＥ患者にみられた抗ＩｇＡ抗体の血清学的検討

Serum IgA deficiency with anti IgA antibodies at the high titer was found in a patient with renal failure due to SLE. Before detection of anti IgA antibodies, she had experienced severe anaphylactoid reactions at the start of the plasma exchange therapy. Afterwards anti IgA antibodies were found by double diffusion in agarose gel and in the IgG fraction of the patient serum, and were directed against only IgA1 subclass. IgA2 was detected by double diffusion method with commercial anti IgA2 antisera. The patient was lacking in IgA, but had secretory component in her saliva.The patient is now well controlled by hemodialysis three times a week for renal failure and by transfusion of washed red blood cells without leukocytes for anemia. Accordingly, irk case of a patient who has little amount of serum IgA requires blood or blood products, anti IgA antibodies should be investigated carefully before administration to avoid anti IgA mediated transfusion reactions.

Significance of sequential changes in serum complement levels during acute anaphylactoid reactions.

Reduced levels of complement fractions C3 and C4 and total hemolytic complement (CH50) are usually attributed to classical complement pathway activation. However, studies in 26 patients undergoing severe anaphylactoid reactions during general anesthesia suggest that these changes may equally reflect plasma dilution and protein redistribution. Twelve patients showed a dramatic fall in complement complexes which tended to resolve after 24 h; however, this fall was not usually associated with the detection of C3 breakdown products or antigen-antibody complexes. Measurement of complement levels is not a reliable index of activation or cleavage when there are dynamic shifts in plasma volume.

Anaphylactoid Pulmonary Edema (“Shock Lung”) and Hypotension After Radiologic Contrast Media Injection

This report illustrates a severe anaphylactoid reaction to sodium diatrizoate infusion during intravenous urography that was characterized chiefly by noncardiogenic pulmonary edema ("shock lung") and protracted hypotension. This occurred in an otherwise previously healthy adult without prior exposure to organic iodides.

The epidemiology and clinical features of anaphylactic reactions in anaesthesia.

Severe anaphylactoid reactions during anaesthesia in 116 patients are described. The majority of patients who reacted to induction agents had previous exposure to the drug, while the majority of patients who reacted to muscle relaxants had not. There was a statistically significant increased incidence of allergy, atopy, asthma and previous reactions in patients who had reactions compared with a control group undergoing uneventful anaesthesia. There was no correlation between abnormalities in immunoglobulins or resting complement levels and a history of allergy or atopy. Antihistamines, steroids and bronchodilators alone did not prevent reactions and three patients reacted to test doses with Althesin. Reactions usually occurred during induction of anaesthesia, but may occur at any time in the perioperative period. No one drug produced reactions that differed in severity or clinical features from any other drug. Clinical features included skin changes, oedema, cardiovascular collapse, bronchospasm, gastrointestinal symptoms, prolonged unconsciousness, convulsions and pulmonary oedema. Four patients died.

Noncardiogenic Pulmonary Edema and Peripheral Vascular Collapse following Cardiopulmonary Bypass

Four instances of severe anaphylactoid reaction occurring subsequent to cardiopulmonary bypass are described. These catastrophic reactions, from which 2 patients died, took place approximately an hour following administration of protamine and were characterized by marked peripheral vasodilatation, loss of capillary membrane integrity, and fulminant noncardiogenic pulmonary edema. Primary cardiac depression was not evident. We hypothesize that protamine was the causative agent in these unusually severe reactions. Differential diagnosis from other causes of acute cardiorespiratory dysfunction depended on early assessment of pulmonary artery and left ventricular filling pressures, cardiac output, respiratory mechanics, and arterial blood gases. Therapy was difficult; success in 1 of the patients seemed to have been effected in part by prompt administration of high-dose corticosteroids and maintenance of peripheral vascular tone with an alpha-adrenergic agonist.

Severe anaphylactoid reaction to radiographic contrast media: Madowitz JS, Schweiger MJ, JAMA241:2813–2815, (Jun) 1979

Severe anaphylactoid reaction to radiographic contrast media: Madowitz JS, Schweiger MJ, JAMA241:2813–2815, (Jun) 1979