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Biphasic and protracted anaphylaxis to iodinated contrast media

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Abstract

Objectives

To investigate the prevalence of biphasic and protracted anaphylaxis to iodinated contrast media (ICM), their risk factors and practical observation duration for detecting biphasic reaction.

Methods

145 patients with ICM anaphylaxis from January 2005–February 2016 were retrospectively categorised into uniphasic, biphasic (anaphylaxis recurrence within 72 h after resolution of initial anaphylaxis) and protracted (anaphylaxis >5 h) reaction groups. Multivariate regression analyses of potential risk factors were performed. We calculated negative predictive value (NPV) for biphasic reactions and additional person-hours required to detect one case during post-anaphylaxis observation.

Results

Fifteen patients had biphasic reactions with secondary reactions with similar or milder severity and six had protracted reactions. Most significant risk factors were anaphylaxis duration >40 min for biphasic reactions (odds ratio (OR), 8.65 [95 % CI, 1.05–70.71]; P=0.044), and additional epinephrine administration within 1 h of initial dosing for protracted reactions (OR, 102.0 [95 % CI, 3.40–3057.25]; P=0.008). A 6-h post-anaphylaxis observation produced NPV of 96.4 %, while requiring a minimum of 65.5 additional person-hours to detect one additional case.

Conclusion

Biphasic and protracted ICM anaphylaxis developed in 10.3 % and 4.1 %, respectively, with revealing risk factors. Six hours could be practical for post-anaphylaxis observation to detect biphasic reaction.

Key points

• Incidence of biphasic anaphylaxis in iodinated contrast media anaphylaxis is 10.3 %.

• Incidence of protracted anaphylaxis in iodinated contrast media anaphylaxis is 4.1 %.

• Initial anaphylaxis >40 min can predict for biphasic anaphylaxis development.

• A 6-h post-anaphylactic observation in ICM-related anaphylaxis seems practical.

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Funding

This study has received no funding from any source.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Tae-Hyung Kim, Soon Ho Yoon, Young Hun Choi & Chang Min Park

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Soon Ho Yoon, Young Hun Choi & Chang Min Park

  3. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

    Suh-Young Lee

  4. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea

    Hye-Ryun Kang & Sang-Heon Cho

  5. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Hye-Ryun Kang & Sang-Heon Cho

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  1. Tae-Hyung Kim
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  2. Soon Ho Yoon
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  4. Young Hun Choi
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Correspondence to Soon Ho Yoon.

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The scientific guarantor of this publication is Soon Ho Yoon.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Institutional Review Board approval was obtained.

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Written informed consent was waived by the Institutional Review Board.

Methodology

• Retrospective

• Case-control study

• Performed at one institution

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Kim, TH., Yoon, S.H., Lee, SY. et al. Biphasic and protracted anaphylaxis to iodinated contrast media. Eur Radiol 28, 1242–1252 (2018). https://doi.org/10.1007/s00330-017-5052-0

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  • DOI: https://doi.org/10.1007/s00330-017-5052-0

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