Iodinated contrast media allergy in patients hospitalized for investigation of chest pain

פרופ` אלון הרשקו

מומחה אימונולוגיה/אלרגולוגיה

קביעת תור אתר הרופא
Background: Iodinated contrast media (ICM) allergy may entail severe adverse events in patients who undergo percutaneous coronary intervention (PCI). Premedication protocols and low-osmolality contrast media have been thought to improve the outcomes of these individuals.
Objective: To assess the prevalence and severity of allergic reactions during PCI in patients admitted for investigation of chest pain.
Methods: This is a retrospective analysis of 13,652 patients who were hospitalized with chest pain during the years 2010-2016, at the Department of Internal Medicine, Meir Medical Center. Patient records were screened for diagnosis of prior ICM allergy. Primary outcomes were: 1) records of previous allergy to ICM; 2) administration of anti-allergic premedication; 3) allergic reactions to the ICM during the procedure.
Results: A total of 13,652 patients were screened. Nine hundred thirty one individuals without prior ICM allergy were referred for PCI, of whom 2 had minor allergic reactions. Previously diagnosed ICM allergy was recorded for 216 subjects (mean age 65.5±10 years, 42% males). Of these, 32 were referred to in-hospital PCI. Premedication was administered in 10 cases only with no documented rationale for not treating the other 22. Only one of the pre-treated patients experienced a reaction attributed to allergy, showing no statistical advantage for premedication. No mortality was documented in the 30 days following PCI among the patients with known ICM allergy.
Conclusion: PCI did not induce substantial allergic reactions to ICM in patients with a previously diagnosed allergy. This study did not demonstrate an advantage for premedication.
Keywords: Iodine allergy; Chest pain; Percutaneous coronary intervention; Allergic reaction; Mortality
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