Griffith Brookles Carola, Bianco Matteo, Pizzimenti Stefano, Gobello Giulia, Biolè Carloalberto, Destefanis Paola, Cerrato Enrico, Chinaglia Alessandra
Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
Department of Medical Sciences, University of Turin, Turin, Italy.
Eur Heart J Case Rep. 2024 May 21;8(6):ytae259. doi: 10.1093/ehjcr/ytae259. eCollection 2024 Jun.
Hypersensitivity reactions to iodinated contrast media (ICM) are frequently encountered in clinical practice. Severe manifestations, despite being infrequent, can be life-threatening and represent an issue when re-administration of ICM is required. Clear recommendations on prevention and management of relapses are still lacking.
We present the cases of two patients presenting with acute coronary syndrome requiring urgent coronary angiography, with an anamnesis of ICM-induced drug reaction with eosinophilia and systemic symptoms syndrome. Both patients safely underwent a coronary angiography with the use of a different ICM (iobitridol) to the one linked to hypersensitivity manifestations, after premedication with corticosteroids and H1 antagonists.
Our experience highlights that in clinical situations in which the use of ICM is urgently needed, premedication with corticosteroids and H1 antagonists together with the choice of an alternative contrast agent (when the culprit is known) represents an effective strategy to perform a potentially life-saving procedure while avoiding serious systemic allergic reactions.
在临床实践中，对碘化造影剂（ICM）的过敏反应屡见不鲜。严重的表现虽不常见，但可能危及生命，且在需要再次使用ICM时成为一个问题。目前仍缺乏关于复发预防和管理的明确建议。
我们报告了两名患有急性冠状动脉综合征需要紧急冠状动脉造影的患者病例，他们有ICM诱发的药物反应伴嗜酸性粒细胞增多和全身症状综合征的既往史。在使用皮质类固醇和H1拮抗剂进行预处理后，两名患者均安全地接受了冠状动脉造影，所用的ICM（碘比醇）与过敏表现相关的那种不同。
我们的经验表明，在急需使用ICM的临床情况下，使用皮质类固醇和H1拮抗剂进行预处理以及选择替代造影剂（当已知罪魁祸首时）是一种有效的策略，既能进行可能挽救生命的操作，又能避免严重的全身性过敏反应。
