Abstract
In forensic pathology routine, fatal cases of contrast agent exposure can be occasionally encountered. In such situations, beyond the difficulties inherent in establishing the cause of death due to nonspecific or absent autopsy and histology findings as well as limited laboratory investigations, pathologists may face other problems in formulating exhaustive, complete reports, and conclusions that are scientifically accurate. Indeed, terminology concerning adverse drug reactions and allergy nomenclature is confusing. Some terms, still utilized in forensic and radiological reports, are outdated and should be avoided. Additionally, not all forensic pathologists master contrast material classification and pathogenesis of contrast agent reactions. We present a review of the literature covering allergic reactions to contrast material exposure in order to update used terminology, explain the pathophysiology, and list currently available laboratory investigations for diagnosis in the forensic setting.
Similar content being viewed by others
References
Schnyder B, Pichler WJ (2009) Mechanisms of drug-induced allergy. Mayo Clin Proc 84:268–272
Farnam K, Chang C, Teuber S, Gershwin ME (2012) Nonallergic drug hypersensitivity reactions. Int Arch Allergy Immunol 159:327–345
Gruchalla RS (2003) Drug allergy. J Allergy Clin Immunol 111:548–559
Solensky R, Khan DA, Bernstein IL, Bloomberg GR, Castells MC, Mendelson LM, Weiss ME, Bernstein DI, Blessing-Moore J, Cox L, Lang DM, Nicklas RA, Oppenheinmer J, Portnoy JM, Randolph C, Schuller DE, Spector S, Tilles S, Wallace D, Dowling PJ, Dykewicz M, Greenberger PA, Macy EM, May KR, Nguygen MT, Schwartz L, Solensky R, Khan DA, Bernstein IL, Bloomberg GR, Castells MC, Mendelson L, Weiss ME, Bernstein DI, Blessing-Moore J, Cox L, Lang DM, Nicklas R, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles SA, Wallace D, Dowling PJ, Dykewicz MS, Greenberger PA, Macy EM, May KR, Nguyen MT, Schwartz LB (2010) Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 105:259–273
Edwards IR, Aronson JK (2000) Adverse drug reactions: definitions, diagnosis, and management. Lancet 356:1255–1259
Shah S, Shah H, Khaskheli MN, Akhtar J (2005) Adverse drug reactions: clinical assessment of drug induced disease. J Ayub Med Coll Abbottabad 17:89–91
Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wüthrich B (2001) A revised nomenclature for allergy. An EACCI position statement from the EACCI nomenclature task force. Allergy 56:813–824
Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC (2004) Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113:832–836
Vickery BP, Chin S, Burks AW (2011) Pathophysiology of food allergy. Pediatr Clin N Am 58:363–376
Bonds RS, Midoro-Horiuti T, Goldblum R (2008) A structural basis for food allergy: the role of cross-reactivity. Curr Opin Allergy Clin Immunol 8:82–86
Romano A, Guéant-Rodriguez RM, Viola M, Gaeta F, Caruso C, Guéant JL (2005) Cross-reactivity among drugs: clinical problems. Toxicology 209:169–179
Pichler WJ (2004) Immune mechanism of drug hypersensitivity. Immunol Allergy Clin N Am 24:373–397
Rajan TV (2003) The Gell-Coombs classification of hypersensitivity reactions: a re-interpretation. Trends Immunol 24:376–379
Galli SJ, Tsai M (2010) Mast cells in allergy and infection: versatile effector and regulatory cells in innate and adaptive immunity. Eur J Immunol 40:1843–1851
Riedl MA, Casillas AM (2003) Adverse drug reactions: types and treatment options. Am Fam Physician 68:1781–1790
Rozieres A, Vocanson M, Saïd BB, Nosbaum A, Nicolas JF (2009) Role of T cells in nonimmediate allergic drug reactions. Curr Opin Allergy Clin Immunol 9:305–310
Singh J, Daftary A (2008) Iodinated contrast media and their adverse reactions. J Nucl Med Technol 36:69–74
Trcka J, Schmidt C, Seitz CS, Bröcker EB, Gross GE, Trautmann A (2008) Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? AJR Am J Roentgenol 190:666–670
Geraldes CF, Laurent S (2009) Classification and basic properties of contrast agents for magnetic resonance imaging. Contrast Media Mol Imaging 4:1–23
Kun T, Jakubowski L (2012) Influence of MRI contrast media on histamine release from mast cells. Pol J Radiol 77:19–24
Böhm I, Heverhagen JT, Klose KJ (2012) Classification of acute and delayed contrast media-induced reactions: proposal of a three step system. Contrast Media Mol Imaging 7:537–541
Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K (1990) Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 175:621–628
Webb JA, Stacul F, Thomsen HS, Morcos SK (2003) Late adverse reactions to intravascular iodinated contrast media. Eur Radiol 13:181–184
Hoffmeister HM, Fuhrer G, Platten HP, Heller W (1989) Changes in complement components after intravascular application of contrast media. Adv Exp Med Biol 247B:585–589
Hoffmeister HM, Fuhrer G, Platten HP, Heller W (1987) Complement activation after the intravascular administration of contrast media: a comparison between ionic and nonionic x-ray contrast media. Rofo 147:673–675
Mikkonen R, Aronen HJ, Kivisaari L, Piilonen A, Syrjäla M (1997) Plasma levels of prekallikrein, alpha-2-macroglobulin and C1-esterase inhibitor in patients with urticarial reaction to contrast media. Acta Radiol 38:466–473
Hoffmeister HM, Heller W (1996) Radiographic contrast media and the coagulation and complement systems. Invest Radiol 31:591–595
Brockow K (2009) Immediate and delayed reactions to radiocontrast media: is there an allergic mechanism? Immunol Allergy Clin N Am 29:453–468
Brockow K (2012) Immediate and delayed cutaneous reactions to radiocontrast media. Chem Immunol Allergy 97:180–190
Nelson KL, Gifford LM, Lauber-Huber C, Gross CA, Lasser TA (1995) Clinical safety of gadopentetate dimeglumine. Radiology 196:439–443
Prince MR, Zhang H, Zou Z, Staron RB, Brill PW (2011) Incidence of immediate gadolinium contrast media reactions. AJR Am J Roentgenol 196:138–143
Fineschi V, Monasterolo G, Rosi R, Turillazzi E (1999) Fatal anaphylaxis shock during a fluorescein angiography. Forensic Sci Int 100:137–142
Su Z, Ye P, Teng Y, Zhang L, Shu X (2012) Adverse reaction in patients with drug allergy history after simultaneous intravenous fundus fluorescein angiography and indocyanine green angiography. J Ocul Pharmacol Ther 28:410–413
Garski TR, Staller BJ, Hepner G, Banka VS, Finney RA Jr (1978) Adverse reactions after administration of indocyanine green. JAMA 240:635
Iseki K, Onoyama K, Fujimi S, Omae T (1980) Shock caused by indocyanine green dye in chronic hemodialysis patients. Clin Nephrol 14:210
Speich R, Saesseli B, Hoffmann U, Neftel KA, Reichen J (1988) Anaphylactoid reactions after indocyanine-green administration. Ann Int Med 109:345–346
Benya R, Quintana J, Brundage B (1989) Adverse reactions to indocyanine green: a case report and a review of the literature. Catheter Cardiovasc Diagn 17:231–233
Wolf S, Arend O, Schulte K, Reim M (1992) Severe anaphylactic reaction after indocyanine green fluorescence angiography. Am J Ophthalmol 114:638–639
Hope-Ross M, Yannuzzi LA, Gragoudas ES, Guyer DR, Slakter JS, Sorenson JA, Krupsky S, Orlock DA, Puliafito CA (1994) Adverse reactions due to indocyanine green. Ophthalmology 101:529–533
Olsen TW, Lim JI, Capone A Jr, Myles RA, Gilman JP (1996) Anaphylactic shock following indocyanine green angiography. Arch Ophthalmol 114:97
Bézu C, Coutant C, Salengro A, Daraï E, Rouzier R, Uzan S (2011) Anaphylactic response to blue dye during sentinel lymph node biopsy. Surg Oncol 20:e55–e59
Barthelmes L, Goyal A, Sudheer P, Mansel RE (2010) Investigation of anaphylactic reaction after patent blue V dye injection. Breast 19:516–520
Manson AL, Juneja R, Self R, Farquhar-Smith P, Macneill F, Seneviratne SL (2012) Anaphylaxis to Patent Blue V: a case series. Asia Pac Allergy 2:86–89
Howard JD, Moo V, Sivalingam P (2011) Anaphylaxis and other adverse reactions to blue dyes: a case series. Anaesth Intensive Care 39:287–292
Cinar H, Koca B, Kesicioglu T, Karabulut K, Karabicak I, Polat C, Tur AH (2012) Isosulfan blue-induced anaphylactic reaction during sentinel lymph node biopsy in breast cancer. Breast 21:220–222
Ionescu A (2009) Bubble trouble: anaphylactic shock, threatened myocardial infarction, and transient renal failure after intravenous echo contrast for left ventricular cavity opacification preceding dobutamine stress echo. Eur J Echocardiogr 10:707–710
Apostolou E, Deckert K, Puy R, Sandrini A, de Leon MP, Douglass JA, Rolland JM, O’hehir RE (2006) Anaphylaxis to Gelofusine confirmed by in vitro basophil activation test: a case series. Anaesthesia 61:264–268
Blokh I, Ganem A, Bonaros EP, Stephen BD, Steinberg B, Rosen SE (2004) Hemodynamic instability after receiving intravenous Perflutren for contrast echocardiography in an elderly female. Echocardiography 21:613–615
Hogan AD, Schwartz LB (1997) Markers of mast cell degranulation. Methods 13:43–52
Amin K (2012) The role of mast cells in allergic inflammation. Respir Med 106:9–14
Ogawa Y, Grant JA (2007) Mediators of anaphylaxis. Immunol Allergy Clin N Am 27:249–260
Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, Bernstein JA, Burks AW, Feldweg AM, Fink JN, Greenberger PA, Golden DB, James JM, Kemp SF, Ledford DK, Lieberman P, Sheffer AL, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D (2010) The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 126:477–480
Edston E, van Hage-Hamsten M (1998) Beta-tryptase measurements post-mortem in anaphylactic deaths and in controls. Forensic Sci Int 93:135–142
D’Errico S, Neri M, Riezzo I, Rossi G, Pomara C, Turillazzi E, Fineschi V (2008) Beta-tryptase and quantitative mast-cell increase in a sudden infant death following hexavalent immunization. Forensic Sci Int 179:e25–e29
Nishio H, Suzuki K (2004) Serum tryptase levels in sudden infant death syndrome in forensic autopsy cases. Forensic Sci Int 139:57–60
Fineschi V, Cecchi R, Centini F, Reattelli LP, Turillazzi E (2001) Immunohistochemical quantification of pulmonary mast-cells and post-mortem blood dosages of tryptase and eosinophils cationic protein in 48 heroin-related deaths. Forensic Sci Int 120:189–194
Edston E, van Hage-Hamsten M (2003) Mast cell tryptase and hemolysis after trauma. Forensic Sci Int 131:8–13
Edston E, van Hage-Hamsten M (1995) Immunoglobulin E, mast cell-specific tryptase and the complement system in sudden death from coronary artery thrombosis. Int J Cardiol 52:77–81
Edston E, Eriksson O, van Hage M (2007) Mast cells tryptase in postmortem serum—reference values and confounders. Int J Legal Med 121:275–280
Mayer DE, Krauskopf A, Hemmer W, Moritz K, Jarisch R, Reiter C (2011) Usefulness of post mortem determination of serum tryptase, histamine and diamine oxidase in the diagnosis of fatal anaphylaxis. Forensic Sci Int 212:96–101
Luongo S, Frontalini C, Pesaresi M, Valsecchi M, Tagliabracci A (2011) Histopathological markers for the diagnosis of anaphylactic death. Med Sci Law 51:30–36
Schwartz HJ, Yunginger JW, Schwartz LB (1995) Is unrecognized anaphylaxis a cause of sudden unexpected death? Clin Exp Allergy 25:866–870
Da Broi U, Moreschi C (2011) Post-mortem diagnosis of anaphylaxis: a difficult task in forensic medicine. Forensic Sci Int 204:1–5
Unkrig S, Hagemeier L, Madea B (2010) Postmortem diagnostics of assumed food anaphylaxis in an unexpected death. Forensic Sci Int 198:e1–e4
Osawa M, Satoh F, Horiuchi H, Tian W, Kugota N, Hasegawa I (2008) Postmortem diagnosis of fatal anaphylaxis during intravenous administration of therapeutic and diagnostic agents: evaluation of clinical laboratory parameters and immunohistochemistry in three cases. Leg Med (Tokyo) 10:143–147
Nishio H, Takai S, Miyazaki M, Horiuchi H, Osawa M, Uemura K, Yoshida K, Mukaida M, Ueno Y, Suzuki K (2005) Usefulness of serum mast cell-specific chymase levels for postmortem diagnosis of anaphylaxis. Int J Legal Med 119:331–334
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Palmiere, C., Comment, L. & Mangin, P. Allergic reactions following contrast material administration: nomenclature, classification, and mechanisms. Int J Legal Med 128, 95–103 (2014). https://doi.org/10.1007/s00414-013-0912-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-013-0912-x