Premedication of patients for prior urticarial reaction to iodinated contrast medium

Amy B. Kolbe, Robert P. Hartman, Tanya L. Hoskin, Rickey E. Carter, Daniel E. Maddox, Christopher H. Hunt, Gina K. Hesley

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose: The purpose of this study was to determine whether premedication of patients with a history of urticaria after low osmolality contrast media (LOCM) results in fewer subsequent reactions, and if a benefit is seen, to determine which premedication regimen results in the fewest reactions. Materials and methods: The subsequent contrast enhanced studies of patients who experienced urticaria after intravenous LOCMbetween 2002 and 2009 were reviewed to determine whether an additional reaction occurred. Patients undergoing subsequent studies received either no premedication, or premedication with diphenhydramine alone, corticosteroid alone, or corticosteroid plus diphenhydramine. Reactions occurring without premedication were termed repeat reactions and reactions occurring after premedication were termed breakthrough reactions. Results: Fifty patients with a history of urticaria after LOCM met the inclusion criteria and underwent 133 subsequent contrast enhanced studies. Repeat reactions occurred in 7.6% (5/66) of subsequent studies in patients receiving no premedication. Breakthrough reactions occurred in 8% (2/25), 46% (12/26), and 44% (7/16) of subsequent studies in patients receiving premedication with diphenhydramine, corticosteroid, and corticosteroid plus diphenhydramine, respectively. All subsequent reactions consisted of urticaria as the most severe manifestation; no hemodynamic instability or respiratory compromise occurred. In multivariate analysis, premedication with corticosteroid was significantly associated with higher rate of breakthrough reaction relative to no premedication (OR 14.3, 95% CI: 4.1-50.4), as was premedication with corticosteroid plus diphenhydramine (OR 8.3, 95% CI: 1.8-37.9). Conclusion: The results suggest that premedication of patients with a history of urticaria after LOCM may not be necessary.

Original languageEnglish (US)
Pages (from-to)432-437
Number of pages6
JournalAbdominal Imaging
Volume39
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Premedication
Contrast Media
Diphenhydramine
Urticaria
Adrenal Cortex Hormones
Osmolar Concentration
Multivariate Analysis
Hemodynamics

Keywords

  • Antihistamine
  • Contrast reaction
  • Corticosteroid
  • Iodinated contrast reaction
  • Premedication
  • Urticaria

ASJC Scopus subject areas

  • Gastroenterology
  • Urology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Kolbe, A. B., Hartman, R. P., Hoskin, T. L., Carter, R. E., Maddox, D. E., Hunt, C. H., & Hesley, G. K. (2014). Premedication of patients for prior urticarial reaction to iodinated contrast medium. Abdominal Imaging, 39(2), 432-437. https://doi.org/10.1007/s00261-013-0058-9

Premedication of patients for prior urticarial reaction to iodinated contrast medium. / Kolbe, Amy B.; Hartman, Robert P.; Hoskin, Tanya L.; Carter, Rickey E.; Maddox, Daniel E.; Hunt, Christopher H.; Hesley, Gina K.

In: Abdominal Imaging, Vol. 39, No. 2, 2014, p. 432-437.

Research output: Contribution to journalArticle

Kolbe, AB, Hartman, RP, Hoskin, TL, Carter, RE, Maddox, DE, Hunt, CH & Hesley, GK 2014, 'Premedication of patients for prior urticarial reaction to iodinated contrast medium', Abdominal Imaging, vol. 39, no. 2, pp. 432-437. https://doi.org/10.1007/s00261-013-0058-9
Kolbe, Amy B. ; Hartman, Robert P. ; Hoskin, Tanya L. ; Carter, Rickey E. ; Maddox, Daniel E. ; Hunt, Christopher H. ; Hesley, Gina K. / Premedication of patients for prior urticarial reaction to iodinated contrast medium. In: Abdominal Imaging. 2014 ; Vol. 39, No. 2. pp. 432-437.
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abstract = "Purpose: The purpose of this study was to determine whether premedication of patients with a history of urticaria after low osmolality contrast media (LOCM) results in fewer subsequent reactions, and if a benefit is seen, to determine which premedication regimen results in the fewest reactions. Materials and methods: The subsequent contrast enhanced studies of patients who experienced urticaria after intravenous LOCMbetween 2002 and 2009 were reviewed to determine whether an additional reaction occurred. Patients undergoing subsequent studies received either no premedication, or premedication with diphenhydramine alone, corticosteroid alone, or corticosteroid plus diphenhydramine. Reactions occurring without premedication were termed repeat reactions and reactions occurring after premedication were termed breakthrough reactions. Results: Fifty patients with a history of urticaria after LOCM met the inclusion criteria and underwent 133 subsequent contrast enhanced studies. Repeat reactions occurred in 7.6{\%} (5/66) of subsequent studies in patients receiving no premedication. Breakthrough reactions occurred in 8{\%} (2/25), 46{\%} (12/26), and 44{\%} (7/16) of subsequent studies in patients receiving premedication with diphenhydramine, corticosteroid, and corticosteroid plus diphenhydramine, respectively. All subsequent reactions consisted of urticaria as the most severe manifestation; no hemodynamic instability or respiratory compromise occurred. In multivariate analysis, premedication with corticosteroid was significantly associated with higher rate of breakthrough reaction relative to no premedication (OR 14.3, 95{\%} CI: 4.1-50.4), as was premedication with corticosteroid plus diphenhydramine (OR 8.3, 95{\%} CI: 1.8-37.9). Conclusion: The results suggest that premedication of patients with a history of urticaria after LOCM may not be necessary.",
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AU - Hunt, Christopher H.

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