SYSTEMIC ANAPHYLACTOID REACTIONS TO IODINATED CONTRAST-MEDIA DURING CARDIAC-CATHETERIZATION PROCEDURES - GUIDELINES FOR PREVENTION, DIAGNOSIS, AND TREATMENT

This report represents the first guidelines for prevention, diagnosis, and treatment of anaphylactoid reactions to contrast media occurring specifically during cardiac catheterization. The incidence of contrast media complications in the catheterization laboratory is 0.23% with 1 death per 55,000. Anaphylactoid reactions are nonimmune mediated, but histamine release and other mediators produce a clinical presentation indistinguishable from anaphylaxis. In patients with known previous r eactions, pretreatment with steroids and diphenhydramine and the use o f nonionic contrast media have significantly reduced the potential of recurrent reaction. Minor reactions such as limited urticaria may be w atched for progression or treatment with diphenhydramine, whereas more serious reactions such as angioedema or laryngeal edema require airwa y stability and ephinephrine administration. Shock should be vigorousl y treated simultaneously with intravenous epinephrine and large volume s of normal saline. If the patient can be stabilized, the study should be completed as histamine, leukotrienes, and other vasoactive product s should be relatively depleted. (C) 1995 Wiley-Liss, Inc.