Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea.
BACKGROUND
Radio-contrast media (CM)-related adverse reactions are important clinical problems that may cause fatal anaphylaxis. Accordingly, it has been common practice to premedicate patients who have had previous reactions to CM with corticosteroids, antihistamines, and H2 blockers to prevent hypersensitive reactions. However, the effectiveness of premedication has not been properly demonstrated, especially in cases related to non-ionic CM. In this study, we evaluated the effectiveness of premedication at preventing of non-ionic CM immediate-type hypersensitivity reactions.


METHODS
A total of 30 patients who had been pretreated with corticosteroid and H1 antihistamines and/or H2 blockers in a 3-year period were enrolled. The results of premedication were evaluated in terms of clinical characteristics and the features of breakthrough reactions.


RESULTS
Hypersensitivity reactions were not prevented in 5 of the 30 patients who had experienced prior CM reactions (overall recurrence rate after premedication 16.7%; 4/17 patients with mild previous reactions, and 1/13 patients with severe previous reactions). The recurrence rate after premedication was significantly higher in patients with mild previous reactions than in those with severe reactions (23.5% vs. 7.7%; p<0.001). The breakthrough reactions were similar to the prior reactions in terms of severity and clinical manifestations.


CONCLUSIONS
Premedication with corticosteroid and H1 antihistamines and/or H2 blockers effectively prevent non-ionic CM-related adverse events in most patients who have had severe previous reactions to CM. However, physicians should be aware of the possibility of premedication failing and of breakthrough reactions, even in cases in which the previous reactions were mild.
Kim
Sae-Hoon
SH
Department of Internal Medicine, Seoul National University College of Medicine, and Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea. imimdr@yahoo.co.kr
Lee
So-Hee
SH
Lee
Sang-Min
SM
Kang
Hye-Ryun
HR
Park
Heung-Woo
HW
Kim
Sun-Sin
SS
Cho
Sang-Heon
SH
Min
Kyung-Up
KU
Kim
You-Young
YY
Chang
Yoon-Seok
YS
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D003952:Diagnostic Imaging; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012008:Recurrence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D003287:Contrast Media; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists