Biphasic and protracted anaphylaxis to iodinated contrast media

• Published in: European radiology 2018-03, Vol.28 (3), p.1242-1252
• Main Authors: Kim, Tae-Hyung, Yoon, Soon Ho, Lee, Suh-Young, Choi, Young Hun, Park, Chang Min, Kang, Hye-Ryun, Cho, Sang-Heon
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Agonists - therapeutic use; Aged; Anaphylaxis; Anaphylaxis - chemically induced; Anaphylaxis - epidemiology; Anaphylaxis - prevention & control; Contrast agents; Contrast Media; Contrast Media - adverse effects; Diagnostic Radiology; Epinephrine; Epinephrine - therapeutic use; Female; Follow-Up Studies; Humans; Imaging; Incidence; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Odds Ratio; Patients; Radiology; Recurrence; Regression analysis; Republic of Korea - epidemiology; Retrospective Studies; Risk analysis; Risk Factors; Time Factors; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5052-0

Objectives To investigate the prevalence of biphasic and protracted anaphylaxis to iodinated contrast media (ICM), their risk factors and practical observation duration for detecting biphasic reaction. Methods 145 patients with ICM anaphylaxis from January 2005–February 2016 were retrospectively categorised into uniphasic, biphasic (anaphylaxis recurrence within 72 h after resolution of initial anaphylaxis) and protracted (anaphylaxis >5 h) reaction groups. Multivariate regression analyses of potential risk factors were performed. We calculated negative predictive value (NPV) for biphasic reactions and additional person-hours required to detect one case during post-anaphylaxis observation. Results Fifteen patients had biphasic reactions with secondary reactions with similar or milder severity and six had protracted reactions. Most significant risk factors were anaphylaxis duration >40 min for biphasic reactions (odds ratio (OR), 8.65 [95 % CI, 1.05–70.71]; P=0.044), and additional epinephrine administration within 1 h of initial dosing for protracted reactions (OR, 102.0 [95 % CI, 3.40–3057.25]; P=0.008). A 6-h post-anaphylaxis observation produced NPV of 96.4 %, while requiring a minimum of 65.5 additional person-hours to detect one additional case. Conclusion Biphasic and protracted ICM anaphylaxis developed in 10.3 % and 4.1 %, respectively, with revealing risk factors. Six hours could be practical for post-anaphylaxis observation to detect biphasic reaction. Key points • Incidence of biphasic anaphylaxis in iodinated contrast media anaphylaxis is 10.3 %. • Incidence of protracted anaphylaxis in iodinated contrast media anaphylaxis is 4.1 %. • Initial anaphylaxis >40 min can predict for biphasic anaphylaxis development. • A 6-h post-anaphylactic observation in ICM-related anaphylaxis seems practical.