Uppal Saurav, DeCicco Anthony E, Intini Anselma, Josephson Richard A
Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine.
Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine.
Int Heart J. 2018 May 30;59(3):622-625. doi: 10.1536/ihj.17-395. Epub 2018 May 6.
Allergic reactions to contrast media are a frequently reported complication of coronary angiography. The majority of patients experience mild, self-limited episodes, but in rare cases patients may experience severe, persistent symptoms. A strategy of premedication with corticosteroids and anti-histamines and an optimal selection of contrast agent is almost always successful in averting contrast reactions, yet a select few patients will continue to have breakthrough events. This is a case of recurrent, severe allergy to contrast media despite standard precautions complicating the treatment of non-ST elevation myocardial infarction (NSTEMI). Our patient was successfully managed with a strategy of rapid desensitization to iodinated contrast media achieved by administering progressively incremental doses of the media.
对比剂过敏反应是冠状动脉造影术常见的并发症。大多数患者经历轻微的、自限性发作，但在极少数情况下，患者可能会出现严重的、持续性症状。使用皮质类固醇和抗组胺药进行预处理的策略以及对比剂的最佳选择几乎总能成功避免对比剂反应，但仍有少数患者会继续出现突破性事件。这是一例尽管采取了标准预防措施，但仍对对比剂反复发生严重过敏反应的病例，使非ST段抬高型心肌梗死（NSTEMI）的治疗变得复杂。我们的患者通过给予逐渐递增剂量的含碘对比剂实现快速脱敏的策略成功得到治疗。
