Beaudouin E, Kanny G, Blanloeil Y, Guilloux L, Renaudin J M, Moneret-Vautrin D A
Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Hôpital Central, 54035 Nancy, France.
Eur Ann Allergy Clin Immunol. 2003 Dec;35(10):382-5.
The use of contrast agent for magnetic resonance imaging improves the effectiveness of this diagnostic examination. Complexes of godolinium, which appear to be well tolerated, are used for this purpose. A few cases of anaphylactic shock have been attributed to these agents. We report a case of anaphylactic shock due to gadoterate meglumine (DOTAREM). While undergoing a magnetic resonance imaging examination, a 33-year-old nonatopic female patient became severely hypotensive, lost consciousness, and had generalized erythema immediately after the intravenous injection of this product. She recovered rapidly after she was given injection of epinephrine and her blood volume was restored with intravenous fluids. That DOTAREM had caused this immediate hypersensitivity reaction was proven by the positivity of prick-test and intradermal test at 10-3 (0.37 mg/ml) and in vitro leukocyte histamine release test. The results of these tests indicated that it was the gadoteric acid rather than the meglumine component of DOTAREM that was responsible: positivity of IDR at 10 mg/ml. Skin tests and leukocyte histamine release test to gadopentetate dimeglumine (MAGNEVIST) were negative. In addition of the exceptional character, this observation provides evidence for an immediate hypersensitivity without cross reactivity with gadopentetate dimeglumine.
磁共振成像中使用造影剂可提高这种诊断检查的有效性。钆的复合物似乎耐受性良好，被用于此目的。已有少数过敏性休克病例归因于这些造影剂。我们报告一例因钆喷酸葡胺（多它灵）导致的过敏性休克。在接受磁共振成像检查时，一名33岁的非特应性女性患者在静脉注射该产品后立即出现严重低血压、意识丧失并伴有全身红斑。在给予肾上腺素注射并用静脉输液恢复血容量后，她迅速康复。通过10 - 3（0.37毫克/毫升）的点刺试验和皮内试验阳性以及体外白细胞组胺释放试验，证实多它灵引起了这种即刻过敏反应。这些试验结果表明，是钆喷酸而非多它灵的葡甲胺成分起了作用：10毫克/毫升时皮内反应阳性。对钆喷酸葡胺（马根维显）的皮肤试验和白细胞组胺释放试验均为阴性。除了这种特殊情况外，该观察结果为一种与钆喷酸葡胺无交叉反应的即刻过敏反应提供了证据。
