MONITORING AND REPORTING DELAYED ADVERSE REACTION TO NONIONIC CONTRAST MEDIA
DOI:
https://doi.org/10.69598/tbps.16.2.97-110Keywords:
delayed adverse reaction, nonionic contrast media, allergic-like reaction, physiologic reactionAbstract
Delayed adverse reaction from nonionic contrast media (nonionic-CM) is not often monitored by healthcare professional and it can be explained from the fact that most of patients develop symptoms after they have been discharged from the hospital. Therefore, the patients may be affected from this condition. The objective of this study was to investigate the reports of delayed adverse reaction from nonionic-CM, clinical manifestation, onset of reaction and primary self-management of patients. This prospective descriptive study was proceeded in patients who underwent the enhanced computerized tomography scan (CT scan) at Siriraj imaging center (outpatients) between November 2019 - March 2020. There were 434 patients recruited into this study and they were divided into 2 groups: Group 1 (87 patients), patients who had acute allergic reaction (within 1 hour after CT scan) and group 2 (347 patients), patients who did not have acute allergic reaction. Both groups were followed-up by telephone at 24 hours and 7 days after receiving nonionic-CM. A total of 61 patients (14.1%) was reported for the delayed adverse reaction and most of them was physiological reaction (82%), while allergic-like reaction was found in 19.7%. Delayed adverse reaction can still be occurred in patient who used to have acute allergic-like reaction. Therefore, healthcare professional should advise all patients about delayed adverse reaction whether they had acute allergic-like reaction. If the patients have the delayed adverse reaction (allergic-like reaction), they should have come back to the hospital for diagnosis and treatment. In addition, they should be given the drug-allergy card and their allergy should be recorded in the system. This can be helpful for monitoring and preventing the repeated allergic reaction to the same nonionic-CM.
References
Chaopathomkul B. Thai national formulary: Contrast media in diagnostic radiology. Thailand Food and Drug Administration. [online]. 2019 [cited May 31, 2021]. Available from: http://www.radiologythailand.org/content/96.
Boyd B, Zamora CA, Castillo M. Managing adverse reactions to contrast agents. Magn Reson Imaging Clin N Am. 2017;25:737-42.
Rydberg J, Charles J, Aspelin P. Frequency of late allergy-like adverse reactions following injection of intravascular non-ionic contrast media. A retrospective study comparing a non-ionic monomeric contrast medium with a non-ionic dimeric contrast medium. Acta Radiol Diagn (Stockh). 1998;39(3):219-22.
Egbert RE, De Cecco CN, Schoepf UJ, McQuiston AD, Meinel FG, Katzberg RW. Delayed adverse reactions to the parenteral administration of iodinated contrast media. AJR Am J Roentgenol. 2014;203(6):1163-70.
Davenport MS, Asch D, Cavallo J, Cohan R, Dillman JR, Ellis JH et al. ACR manual on contrast media. American College of Radiology [online]. 2018 [cited May 26, 2021]. Available from: www.acr.org/Clinical-Resources/Contrast-Manual.
Tasker F, Fleming H, McNeill G, Creamer D, Walsh S. Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media. Clin Exp Dermatol. 2019;44:844-60.
Brockow K, Romano A, Aberer W, Bircher AJ, Barbaud A, Bonadonna P, et al. Skin testing in patients with hypersensitivity reactions to iodinated contrast media-a European multicenter study. Allergy. 2009;64(2):234-41.
Brockow K, Christiansen C, Kanny G, Clement O, Barbaud A, Bircher A, et al. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005;60(2):150-8.
Gomez E, Ariza A, Blanca-Lopez N, Torres MJ. Nonimmediate hypersensitivity reactions to iodinated contrast media. Curr Opin Allergy Clin Immunol. 2013;13(4):345-53.
Akiyama M, Nakada T, Sueki H, Fujisawa R, Iijima M. Drug eruption caused by nonionic iodinated X-ray contrast media. Acad Radiol. 1998;5(1):159-61.
Courvoisier S, Bircher AJ. Delayed-type hypersensitivity to a nonionic, radiopaque contrast medium. Allergy. 1998;53(12):1221-4.
Watanabe H, Sueki H, Nakada T, Akiyama M, Iijima M. Multiple fixed drug eruption caused by iomeprol (Iomeron), a nonionic contrast medium. Dermatology. 1999;198(3):291-4.
Brockow K. Immediate and delayed cutaneous reactions to radiocontrast media. Chem Immunol Allergy. 2012;97:180-90.
Bellin MF, Stacul F, Webb JA, Thomsen HS, Morcos SK, Almen T, et al. Late adverse reactions to intravascular iodine based contrast media: an update. Eur Radiol. 2011;21(11):2305-10.
Sutton AG, Finn P, Grech ED, Hall JA, Stewart MJ, Davies A, et al. Early and late reactions after the use of iopamidol 340, ioxaglate 320, and iodixanol 320 in cardiac catheterization. Am Heart J. 2001;141(4):677-83.
Loh S, Bagheri S, Katzberg RW, Fung MA, Li C-S. Delayed adverse reaction to contrast-enhanced CT: a prospective single-center study comparison to control group without enhancement. Radiology. 2010;255(3):764-71.
Lemeshow S, Hosmer DW, Klar J, Lwanga SK, World Health Organization. Sample size for case-control studies. In: Lemeshow S, editors. Adequacy of sample size in health studies. Chichester: Wiley; 1990. p.16-20.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharma col Ther. 1981;30:239-45.
Iordache AM, Docea AO, Buga AM, Mitrut R, Albulescu D, Zlatian O, et al. The incidence of skin lesions in contrast media-induced chemical hypersensitivity. Exp Ther Med. 2019;17(2):1113-24.
Lapi F, Cecchi E, Pedone C, Attanasio F, Banchelli G, Vannacci A, et al. Safety aspects of iodinated contrast media related to their physicochemical properties: a pharmacoepidemiology study in two Tuscany hospitals. Eur J Clin Pharmacol. 2008;64(7):723-37.
Kim YS, Choi YH, Cho YJ, Lee S, Yoon SH, Park CM, et al. Incidence of breakthrough reaction in patients with prior acute allergic-like reactions to iodinated contrast media according to the administration route. Korean J Radiol. 2018;19(2):352-7.
Christiansen C, Pichler WJ, Skotland T. Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations. Eur Radiol. 2000;10(12):1965-75.
Panto PN, Davies P. Delayed reactions to urographic contrast media. Br J Radiol. 1986;59(697):41-4.
Abe S, Fukuda H, Tobe K, Ibukuro K. Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium. Eur Radiol. 2016;26(7):2148-54.
Jung JW, Choi YH, Park CM, Park HW, Cho SH, Kang HR. Outcomes of corticosteroid prophylaxis for hypersensitivity reactions to low osmolar contrast media in high-risk patients. Ann Allergy Asthma Immunol. 2016;117(3):304-9.
Lee SY, Yang MS, Choi YH, Park CM, Park HW, Cho SH, et al. Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients. Ann Allergy Asthma Immunol. 2017;118(3):339-44.
Park HJ, Park JW, Yang MS, Kim MY, Kim SH, Jang GC, et al. Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study. Eur Radiol. 2017;27(7):2886-93.
Maddox TG. Adverse reactions to contrast material: recognition, prevention, and treatment. Am Fam Physician. 2002;66(7):1229-34.
Subathra A, Sandhiya S, Kesavan R. An analysis of adverse drug reactions to radiographic contrast media reported during a 3 year period in a tertiary care hospital in south India. Indian J Physiol Pharmacol. 2014;58(1):45-50.
Inbaraj SD, Sidhu GR, Muthiah NS. Pharmacovigilance of radiographic contrast-induced adverse drug reactions in a tertiary care hospital of south India. Asian J Pharm Clin Res. 2017;10:364-6.
Patel D, Pillai A, Kausar F. A study of adverse drug reactions to iodinated contrast agents in tertiary care teaching hospital. Int J Basic Clin Pharmacol. 2019;8:2440-4.
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