Adverse reactions during procedures hypersensitivity to contrast agents and dyes. Lunes 11 de mayo
Adverse reactions during procedures hypersensitivity to contrast agents and dyes
Authors: Christine Schönmann, MD, Knut Brockow, MD
Abstract
Objective
This review provides an overview of the literature on hypersensitivity reactions during procedures to commonly used contrast agents and dyes. A synthesis of current knowledge on clinical symptoms, epidemiology and risk factors, pathomechanism, and management of hypersensitivity reactions to these substances is presented.
Data Sources
A literature search was conducted through Medline. Included were peer-reviewed articles written in English between 2000 and 2019.
Study Selections
Relevant clinical studies, experimental studies, and review articles have been selected. Additionally, case reports have been included if they carried significant information about rare clinical forms of hypersensitivity reactions, disease mechanisms, or therapy.
Results
An allergological workup is only indicated for patients with a history of immediate (IHR) and nonimmediate hypersensitivity reactions (NIHR) but not for toxic or unrelated adverse events. Skin tests with or without experimental cellular laboratory tests in patients with previous reactions can provide evidence for an allergic mechanism. Positive skin tests indicating allergy are more common in severe reactions. If the adverse event was allergic, skin testing of alternatives is helpful for the selection of other contrast agents for future procedures. Premedication alone may be insufficient in these cases, and breakthrough reactions occur. For nonallergic reactions, change of contrast agent and premedication is often but not always sufficient to suppress reactions.
Conclusion
Patients with previous NIHR or IHR, especially moderate and severe IHR, needing potential re-administration of contrast agents should be skin tested to identify an allergic mechanism as well as alternative agents to be used for future procedures.
Una vez más vemos la importancia de que las instituciones de salud cuenten con un médico alergólogo en su planta física para enfrentar este tipo de reacciones y realizar un manejo adecuado y oportuno; los medios de contraste y las diferentes sustancias utilizadas en las imágenes diagnósticas son elementos primordiales a la hora de hacer un adecuado diagnóstico de los pacientes en concordancia con sus diferentes patologías, de ahí la importancia de tener claro cuales son las alternativas con las que se cuenta y los estudios indicados a la hora de enfrentarnos con un paciente que presenta cualquier tipo de reacción de hipersensibilidad inmediata o tardía y a partir de ellas definir los pasos más adecuados para indicar o no la alternativa de un estudio imagenológico, sopesando el riesgo beneficio y generando una adecuada toma de decisiones siempre a favor del paciente.
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