Macy Eric M
Allergy Specialist and Researcher in the Department of Allergy at the San Diego Medical Center in CA. He is a Partner Physician with the Southern California Permanente Medical Group, and an Assistant Clinical Professor of Medicine at the University of California, San Diego.
Perm J. 2018;22:17-072. doi: 10.7812/TPP/17-072.
Radiocontrast-associated acute-onset hypersensitivity reactions now occur less frequently than before 1990, when high-osmolar, ionic, radiocontrast agents were widely used. Premedication with corticosteroids and antihistamines does not reliably prevent recurrent low-osmolar radiocontrast-associated acute hypersensitivity reactions. Corticosteroid prophylaxis for acute hypersensitivity currently causes more morbidity than benefit. The specific radiocontrast agent that is associated with a patient's adverse reaction must be displayed in the drug intolerance or drug "allergy" field of their electronic health record to enable effective management and prevention of future reactions. The term iodine allergy should never be used in the context of radiocontrast-associated adverse reactions because it leads to poorer clinical outcomes. The time to onset of the reaction and the nature of the reaction must be noted in enough detail in the drug intolerance comment fields in the electronic health record to determine the potential mechanism for the reaction and to enable selection of the appropriate radiocontrast material for future exposures. Most individuals with a history of radiocontrast agent hypersensitivity can be effectively managed by selecting an alternative radiocontrast agent, without any premedication. Radiology Departments, catheterization laboratories, and all physicians who use parenteral radiocontrast media must have management plans in place to treat severe acute reactions when they occur. Patients should be informed that delayed-onset reactions, mostly benign rashes within one week of exposure, are as common or more common than acute reactions. Future radiocontrast-associated acute and delayed-onset reactions can be minimized, but never completely avoided, by using an appropriate alternative agent.
与1990年以前相比，现在放射性造影剂相关的急性超敏反应发生频率降低，当时高渗离子型放射性造影剂被广泛使用。使用皮质类固醇和抗组胺药进行预处理并不能可靠地预防复发性低渗放射性造影剂相关的急性超敏反应。目前，皮质类固醇预防急性超敏反应造成的不良影响超过了其益处。与患者不良反应相关的特定放射性造影剂必须显示在其电子健康记录的药物不耐受或药物“过敏”字段中，以便有效地管理和预防未来的反应。在放射性造影剂相关不良反应的背景下，绝不应使用碘过敏一词，因为这会导致较差的临床结果。必须在电子健康记录的药物不耐受注释字段中详细记录反应的发作时间和反应性质，以确定反应的潜在机制，并为未来的接触选择合适的放射性造影剂。大多数有放射性造影剂过敏史的个体可以通过选择替代放射性造影剂进行有效管理，而无需任何预处理。放射科、心导管室以及所有使用胃肠外放射性造影剂的医生必须制定管理计划，以便在严重急性反应发生时进行治疗。应告知患者，迟发性反应，大多是在接触后一周内出现的良性皮疹，与急性反应一样常见或更常见。通过使用合适的替代剂，未来与放射性造影剂相关的急性和迟发性反应可以减至最低，但永远无法完全避免。
