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Internal and Emergency Medicine

, Volume 9, Issue 3, pp 325–330 | Cite as

Anaphylaxis caused by intravenous fluorescein: clinical characteristics and review of literature

  • Sang Ook Ha
  • Dae Yong Kim
  • Chang Hwan Sohn
  • Kyoung Soo Lim
EM - ORIGINAL

Abstract

Anaphylaxis is a severe, potentially fatal, systemic allergic reaction that suddenly occurs after contact with an allergy-causing substance. The aims of this study were to evaluate the clinical characteristics and outcomes of patients who were diagnosed with anaphylaxis to fluorescein. The medical records of patients with anaphylaxis to intravenous fluorescein angiography (IVFA) admitted to the emergency department between January 2010 and June 2012 were retrospectively reviewed. Among 12,005 times of IVFA, a total of 10 patients (0.083 %) were included in this study. The mean age was 58.3 years, and 50.0 % were men. The most common presentation was hypotension (systolic blood pressure <90 mmHg) (70 %) followed by nausea and vomiting (60 %). Especially, patients with diabetes were more prone to develop hypotension and most hypotensive events occurred in less than 3 min. All of our patients recovered without sequelae and mortality following prompt and proper intervention. Although the incidence is low, anaphylaxis due to intravenous fluorescein can occur during IVFA. Physicians should be aware of this possible complication, and be prepared to treat it.

Keywords

Anaphylaxis Characteristics Fluorescein Hypotension 

Notes

Conflict of interest

The authors declare no conflicts of interest. This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

References

  1. 1.
    Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O’Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW (2006) Second symposium on the definition and management of anaphylaxis: summary report—second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med 47:373–380PubMedCrossRefGoogle Scholar
  2. 2.
    Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SGA, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O’Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FER, Thomas S, Wood JP, Decker WW (2006) Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 117:391–397PubMedCrossRefGoogle Scholar
  3. 3.
    Wang J, Sampson HA (2007) Food anaphylaxis. Clin Exp Allergy 37:651–660PubMedCrossRefGoogle Scholar
  4. 4.
    Barnard JH (1973) Studies of 400 Hymenoptera sting deaths in the United States. J Allergy Clin Immunol 52:259–264PubMedCrossRefGoogle Scholar
  5. 5.
    Greenberger PA, Rotskoff BD, Lifschultz B (2007) Fatal anaphylaxis: postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol 98:252–257PubMedCrossRefGoogle Scholar
  6. 6.
    Kim SH, Lee SH, Lee SM, Kang HR, Park HW, Kim SS, Cho SH, Min KU, Kim YY, Chang YS (2011) Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur J Radiol 80:363–367PubMedCrossRefGoogle Scholar
  7. 7.
    Brockow K (2009) Immediate and delayed reactions to radiocontrast media: is there an allergic mechanism? Immunol Allergy Clin N Am 29:453–468CrossRefGoogle Scholar
  8. 8.
    Wang CL, Cohan RH, Ellis JH, Caoili EM, Wang G, Francis IR (2008) Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. AJR Am J Roentgenol 191:409–415PubMedCrossRefGoogle Scholar
  9. 9.
    Lira RP, Oliveira CL, Marques MV, Silva AR, Pessoa Cde C (2007) Adverse reactions of fluorescein angiography: a prospective study. Arq Bras Oftalmol 70:615–618PubMedCrossRefGoogle Scholar
  10. 10.
    Scranton SE, Gonzalez EG, Waibel KH (2009) Incidence and characteristics of biphasic reactions after allergen immunotherapy. J Allergy Clin Immunol 123:493–498PubMedCrossRefGoogle Scholar
  11. 11.
    Marmor MF, Ravin JG (2011) Fluorescein angiography: insight and serendipity a half century ago. Arch Ophthalmol 129:943–948PubMedCrossRefGoogle Scholar
  12. 12.
    Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields W, Zang E (1986) Fluorescein angiography complication survey. Ophthalmology 93:611–617PubMedCrossRefGoogle Scholar
  13. 13.
    Kwiterovich KA, Maguire MG, Murphy RP, Schachat AP, Bressler NM, Bressler SB, Fine SL (1991) Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 98:1139–1142PubMedCrossRefGoogle Scholar
  14. 14.
    Breidablik A, De Pater GH, Walther C, Nopp A, Guttormsen AB (2012) Intravenous fluorescein as a cause of immunoglobulin E-mediated anaphylactic shock. Acta Anaesthesiol Scand 56:1066–1068PubMedCrossRefGoogle Scholar
  15. 15.
    Brown AF, McKinnon D, Chu K (2001) Emergency department anaphylaxis: a review of 142 patients in a single year. J Allergy Clin Immunol 108:861–866PubMedCrossRefGoogle Scholar
  16. 16.
    Kemp SF, Lockey RF, Wolf BL, Lieberman P (1995) Anaphylaxis. A review of 266 cases. Arch Intern Med 155:1749–1754PubMedCrossRefGoogle Scholar
  17. 17.
    Smit DV, Cameron PA, Rainer TH (2005) Anaphylaxis presentations to an emergency department in Hong Kong: incidence and predictors of biphasic reactions. J Emerg Med 28:381–388PubMedCrossRefGoogle Scholar
  18. 18.
    Greene GS, Bell LW, Hitching RA, Spaeth GL (1976) Adverse reaction to intravenous fluorescein: evidence for sex difference. Ann Ophthalmol 8:533–536PubMedGoogle Scholar
  19. 19.
    Butner RW, McPherson AR (1983) Adverse reactions in intravenous fluorescein angiography. Ann Ophthalmol 15:1084–1086PubMedGoogle Scholar
  20. 20.
    Zografos L (1983) International survey on the incidence of severe or fatal complications which may occur during fluorescein angiography. J Fr Ophtalmol 6:495–506PubMedGoogle Scholar
  21. 21.
    Pacurariu RI (1982) Low incidence of side effects following intravenous fluorescein angiography. Ann Ophthalmol 14:32–36PubMedGoogle Scholar
  22. 22.
    Kwan AS, Barry C, McAllister IL, Constable I (2006) Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience. Clin Exp Ophthalmol 34:33–38CrossRefGoogle Scholar
  23. 23.
    Bearelly S, Rao S, Fekrat S (2009) Anaphylaxis following intravenous fluorescein angiography in a vitreoretinal clinic: report of 4 cases. Can J Ophthalmol: Journal canadien d’ophtalmologie 44:444–445PubMedCrossRefGoogle Scholar
  24. 24.
    Balbino M, Silva G, Correia GC (2012) Anaphylaxis with convulsions following intravenous fluorescein angiography at an outpatient clinic. Einstein 10:374–376PubMedGoogle Scholar
  25. 25.
    Tole JW, Lieberman P (2007) Biphasic anaphylaxis: review of incidence, clinical predictors, and observation recommendations. Immunol Allergy Clin N Am 27:309–326 (viii)CrossRefGoogle Scholar

Copyright information

© SIMI 2013

Authors and Affiliations

  • Sang Ook Ha
    • 1
  • Dae Yong Kim
    • 2
  • Chang Hwan Sohn
    • 1
  • Kyoung Soo Lim
    • 1
  1. 1.Department of Emergency Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  2. 2.Department of Emergency Medicine, Eulji Medical CenterUniversity of Eulji College of MedicineSeoulKorea

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