Management of acute coronary syndromes requiring coronary angiography in patients with drug reaction with eosinophilia and systemic symptoms syndrome induced by iodinated contrast media: two case reports and narrative review

Abstract Background Hypersensitivity reactions to iodinated contrast media (ICM) are frequently encountered in clinical practice. Severe manifestations, despite being infrequent, can be life-threatening and represent an issue when re-administration of ICM is required. Clear recommendations on preven...

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Bibliographic Details
Published in:European heart journal : case reports 2024-06, Vol.8 (6), p.ytae259-ytae259
Main Authors: Griffith Brookles, Carola, Bianco, Matteo, Pizzimenti, Stefano, Gobello, Giulia, Biolè, Carloalberto, Destefanis, Paola, Cerrato, Enrico, Chinaglia, Alessandra
Format: Article
Language:English
Subjects:
Allergic reaction
Allergy
Angiography
Apixaban
Cardiac patients
Care and treatment
Case Series
Complications and side effects
Contrast media
Coronary heart disease
Corticosteroids
Eosinophilia
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Summary:Abstract Background Hypersensitivity reactions to iodinated contrast media (ICM) are frequently encountered in clinical practice. Severe manifestations, despite being infrequent, can be life-threatening and represent an issue when re-administration of ICM is required. Clear recommendations on prevention and management of relapses are still lacking. Case summary We present the cases of two patients presenting with acute coronary syndrome requiring urgent coronary angiography, with an anamnesis of ICM-induced drug reaction with eosinophilia and systemic symptoms syndrome. Both patients safely underwent a coronary angiography with the use of a different ICM (iobitridol) to the one linked to hypersensitivity manifestations, after premedication with corticosteroids and H1 antagonists. Discussion Our experience highlights that in clinical situations in which the use of ICM is urgently needed, premedication with corticosteroids and H1 antagonists together with the choice of an alternative contrast agent (when the culprit is known) represents an effective strategy to perform a potentially life-saving procedure while avoiding serious systemic allergic reactions.
ISSN:2514-2119
2514-2119
DOI:10.1093/ehjcr/ytae259