Department of Radiology, University of North Carolina, Chapel Hill.
Cincinnati Children's Hospital Medical Center, Ohio.
Invest Radiol. 2018 Sep;53(9):551-554. doi: 10.1097/RLI.0000000000000452.
The aim of this study was to determine the severity of breakthrough reactions to gadobenate dimeglumine in patients premedicated with a 13-hour premedication regimen.
Institutional review board approval was obtained and informed consent waived for this Health Insurance Portability and Accountability Act-compliant retrospective cohort study. All acute allergic-like reactions to gadobenate dimeglumine from 11/1/2008 to 1/31/2016 were identified. Of these, 19 allergic-like reactions followed 13-hour premedication: 150 mg prednisone and 50 mg diphenhydramine (ie, "breakthrough reactions"). Reasons for premedication, risk factors, index reaction characteristics, and breakthrough reaction characteristics were catalogued. Reaction severities were assigned using American College of Radiology guidelines. Severities of breakthrough (n = 19) and nonbreakthrough reactions (n = 97) were compared with the Cochran-Armitage test for trend.
Premedication was most commonly given (63% [12/19]) for a previous allergic-like reaction to gadolinium-based contrast material (GBCM); in 37% (7/19), it was given for a different risk factor. In those premedicated for a previous allergic-like reaction to GBCM of known severity (n = 9), the breakthrough reaction severity was the same as index reaction severity in 56% (5/9), less severe in 11% (1/9), and of greater severity in 33% (3/9). Two severe breakthrough reactions occurred; both were in subjects premedicated for risk factors other than a previous GBCM reaction. No subjects died. Five subjects were reexposed to GBCM a total of 9 times; no repeat breakthrough reactions occurred. Breakthrough reactions were more severe than nonbreakthrough reactions (P = 0.046), but the level of significance was borderline.
Premedication does not eliminate severe reactions to gadobenate dimeglumine. Breakthrough reactions to gadobenate dimeglumine can be of greater severity than index reactions.
本研究旨在确定经 13 小时预给药方案预给药的患者中出现钆喷酸葡胺突破性反应的严重程度。
本符合《健康保险流通与责任法案》的回顾性队列研究获得了机构审查委员会的批准，并豁免了知情同意。从 2008 年 11 月 1 日至 2016 年 1 月 31 日，所有对钆喷酸葡胺的急性过敏样反应均被确定。其中，19 例过敏样反应发生在 13 小时预给药后：150mg 泼尼松和 50mg 苯海拉明（即“突破性反应”）。记录预给药的原因、危险因素、指数反应特征和突破性反应特征。根据美国放射学院指南分配反应严重程度。使用 Cochran-Armitage 检验进行趋势比较，比较突破性（n=19）和非突破性反应（n=97）的严重程度。
预给药最常用于（63%[19/29]）先前对基于钆的对比剂（GBCM）的过敏样反应；在 37%（7/19）的情况下，是为了不同的危险因素而给药。在已知严重程度（n=9）的先前 GBCM 过敏样反应预给药的患者中，56%（5/9）的突破性反应严重程度与指数反应严重程度相同，11%（1/9）的反应严重程度较轻，33%（3/9）的反应严重程度较重。发生了 2 例严重的突破性反应；两者均发生在因非先前 GBCM 反应的危险因素而预给药的患者中。没有患者死亡。5 名患者总共 9 次再次接触 GBCM；没有发生重复的突破性反应。突破性反应比非突破性反应更严重（P=0.046），但显著性水平为边缘。
预给药并不能消除对钆喷酸葡胺的严重反应。钆喷酸葡胺的突破性反应可能比指数反应更严重。
