Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Pain Physician. 2012 Sep-Oct;15(5):E665-75.
Millions of interventional pain procedures are performed each year in the United States. Interventional pain physicians commonly administer radiocontrast media (RCM) under fluoroscopy for these procedures. However, RCM can cause various types of hypersensitivity or allergic type reactions, in an acute or delayed fashion. Furthermore, some patients report a prior history of hypersensitivity reactions to RCM when presenting to the interventional pain clinic. Both scenarios present challenges to the interventional pain physician.
To describe the various types of hypersensitivity reactions to RCM, as well as strategies to prevent and manage these reactions, within the context of interventional pain practice.
A review of the literature from 1975 through 2011 regarding allergic type reactions to RCM, as well as iodine, and shellfish allergy, was undertaken in an effort to review and develop recommendations on managing these patients presenting to the interventional pain clinic. Keywords used in the literature search were: radiocontrast media, contrast allergy, contrast reaction, iodine allergy, shellfish allergy, and fluoroscopy. The included articles were concerned with the basic or clinical science of contrast allergy, including the physiology, epidemiology, diagnosis, and management of such reactions. Meta-analysis, review articles, and case reports addressing contrast media reactions were also included. Articles which discussed contrast media reactions in a peripheral fashion were excluded.
In reviewing the literature, it is apparent that the mechanisms and pathophysiology of RCM hypersensitivity reactions are still being characterized, which should soon lead to improved screenings, as well as prevention and treatment strategies. Many common themes are described throughout the literature regarding patient risk factors, testing, prevention,diagnosis, and treatment of RCM allergic-type reactions.
The current review did not perform a meta-analysis of the available data, as most of the available articles were trials that were randomly controlled. Therefore, the conclusions of the present article are general, and qualitative in nature.
Although the mechanisms of various RCM allergic-type reactions are not entirely understood, the interventional pain physician should have a basic understanding of patient risk factors, prevention, diagnosis, and treatment of these reactions. The current review allowed for prevention and treatment strategies for managing patients with RCM hypersensitivity reactions.
在美国，每年都有数百万人次接受介入性疼痛治疗。介入性疼痛医师通常在透视下为这些治疗过程中使用放射性对比剂（RCM）。然而，RCM 会导致各种类型的过敏或过敏样反应，包括急性和延迟性反应。此外，一些患者在就诊于介入性疼痛诊所时，报告有 RCM 过敏史。这两种情况都给介入性疼痛医师带来了挑战。
描述 RCM 过敏反应的各种类型，以及在介入性疼痛治疗实践中预防和管理这些反应的策略。
回顾了 1975 年至 2011 年期间关于 RCM、碘和贝类过敏的过敏样反应的文献，旨在回顾和制定有关管理这些就诊于介入性疼痛诊所的患者的建议。文献检索中使用的关键词包括：放射性对比剂、对比剂过敏、对比剂反应、碘过敏、贝类过敏和透视。纳入的文章涉及与对比剂过敏的基础或临床科学相关的内容，包括对比剂过敏的生理学、流行病学、诊断和管理。还包括了关于对比剂反应的荟萃分析、综述文章和病例报告。排除了那些仅在周边讨论对比剂反应的文章。
在回顾文献时，很明显，RCM 过敏反应的机制和病理生理学仍在研究中，这将很快导致改进的筛查以及预防和治疗策略。文献中描述了许多与患者风险因素、检测、预防、诊断和治疗 RCM 过敏样反应相关的共同主题。
目前的综述并未对现有数据进行荟萃分析，因为大多数现有文章都是随机对照试验。因此，本文的结论是一般性的，并且具有定性性质。
尽管各种 RCM 过敏样反应的机制尚未完全理解，但介入性疼痛医师应该对这些反应的患者风险因素、预防、诊断和治疗有基本的了解。本综述允许制定管理 RCM 过敏反应患者的预防和治疗策略。
