title: Effects of beta-adrenergic and calcium antagonists on the development of anaphylactoid reactions from radiographic contrast media during cardiac angiography.
abstract: Anaphylactoid reactions (ARs) occurring in patients receiving propranolol have been described as unusually severe and having a "sluggish" response to epinephrine. Although the mechanism of ARs to iodinated radiographic contrast media is not IgE mediated, because of widespread use of beta-adrenergic blocking agents, we undertook a prospective study to determine the incidence of AR to radiographic contrast media during cardiac angiography. Nine hundred fifty-two consecutive patients were divided into four groups according to concomitant chronic medications. Group I (447 patients) were receiving no beta-adrenergic blocking agents or calcium antagonists. Group II (216 patients) were receiving a beta-adrenergic blocking agent. Group III (147 patients) were receiving a calcium antagonist but not a beta-adrenergic blocking agent. Group IV (142 patients) were receiving both a calcium antagonist and a beta-adrenergic blocking agent. The reaction rates, respectively, in the four groups were 4.47%, 7.41%, 5.44%, and 4.93%. The rates of ARs were not associated with the use of concomitant medications in any of the groups (chi 2 = 2.531; p = 0.47). The probability of a type II error in comparison of groups I and II was 0.75 should the true incidence of reactions in patients receiving beta-adrenergic antagonists be 7.41%. No difference in the incidence of AR was observed between patients taking selective and nonselective beta-adrenergic blocking agents in group II. Specific ARs occurring in patients receiving beta-adrenergic blocking agents were usually mild and often without need for specific pharmacotherapy.
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000790:Angiocardiography; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D003973:Diatrizoate / Q000009:adverse effects*; D003974:Diatrizoate Meglumine / Q000009:adverse effects*; D004338:Drug Combinations / Q000009:adverse effects; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced*; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D004338:Drug Combinations; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; C027278:urovision