Department of Diagnostic Imaging, Tan Tock Seng Hospital, Singapore.
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2023 Mar 30;52(3):116-124. doi: 10.47102/annals-acadmedsg.2022223.
In collaboration with the Department of Rheumatology, Allergy and Immunology, our study aims to review the outcomes of and propose an improved workflow for the management of patients with prior hypersensitivity reactions to iodinated contrast media (ICM).
Outpatients coming for contrast-enhanced computed tomography (CECT) were stratified into 3 categories (definite, unconfirmed and inaccurate) based on likelihood of their contrast hypersensitivity label. Patients could be offered a different ICM, receive the same ICM, or be referred to an allergist for further evaluation. There were 4 outcomes: (1) alternative ICM tolerated; (2) same ICM tolerated again; (3) patient developed a hypersensitivity reaction to either alternative or original ICM; and (4) CECT was deferred until assessment by an allergist. Comparison was made pre- and post-intervention to see if patient outcomes were improved.
There were 132 patients who made a total of 154 visits (90.3% had documented contrast hypersensitivity). Post-intervention, the number of visits postponed for premedication decreased (81.0% to 34.7%). There was a reduction in hypersensitivity reactions (from 42.9% to 14.3%). Of the 12 patients assessed by the allergist, 6 could continue using the same or alternative ICM, 4 were advised to abstain from further contrast administration and 2 were pending testing with a third agent.
Active intervention by the radiologist can decrease the number of postponed, converted or cancelled CECT studies as well as reduce the number of adverse allergic-like events. Direct collaboration between radiologist and allergist for specific cases may be helpful in patients who will likely need future/repeated CECTs.
本研究与风湿免疫科合作，旨在回顾和提出改进流程，以管理有碘对比剂（ICM）过敏史的患者。
根据对比剂过敏的可能性，将接受增强 CT（CECT）的门诊患者分为 3 类（明确、未确认和不准确）。患者可以选择另一种 ICM、再次使用相同的 ICM，或转介给过敏科医生进行进一步评估。共有 4 种结果：（1）替代 ICM 可耐受；（2）再次耐受相同的 ICM；（3）患者对替代或原始 ICM 产生过敏反应；（4）CECT 推迟至过敏科评估。比较干预前后的结果，以确定患者的结局是否得到改善。
共有 132 名患者进行了 154 次就诊（90.3%有记录的对比剂过敏史）。干预后，因需要预用药而推迟的就诊次数减少（从 81.0%降至 34.7%）。过敏反应的发生率从 42.9%降至 14.3%。在由过敏科医生评估的 12 名患者中，6 名可以继续使用相同或替代的 ICM，4 名被建议避免进一步使用对比剂，2 名正在等待第三种药物的检测。
放射科医生的积极干预可以减少推迟、转换或取消的 CECT 研究数量，并减少不良过敏样事件的发生。在需要多次重复 CECT 的患者中，放射科医生与过敏科医生的直接合作可能会有所帮助。
