Management of radio-contrast allergy in radio-contrast allergic patients undergoing coronary angiography and intervention

Objectives Radiocontrast agents (RCA) allergy occurs in 0.04 % – 0.22 % of patients. However, the risk of allergic reaction increases as 16 % to 35 % in patients with prior RCA allergy. Herein we reported our experience in patients with a prior history of RCA induced anaphylaxis who underwent coronary angiography (CAG) and intervention.
Methods This retrospective study included 11 patients with prior history of RCA anaphylaxis who underwent CAG and / or intervention at our clinic between May 2016 and September 2019. The mean age of the patients was 61.8±8.99 years, 8 (72.7 %) were female, 9 (81.8 %) had hypertension, 6 (54.5 %) – diabetes mellitus, 11 (100 %) – dyslipidemia, 8 (72.7 %) patients were current smokers, 4 had prior history RCA allergy after i.v. RCA administration in contrast enhanced computed tomography and 7 patients experienced RCA allergy after CAG. All patients had prior severe anaphylaxis reaction. All patients were pretreated with intravenous feniramin maleat 45.5 mg and methylprednizolone 80 mg one hour before the procedure and dexametazon 8 mg after the procedure.
Results CAG and intervention was successfully completed in all patients. Two patients had breakthrough RCA induced anaphylaxis, theyhad urticarial, itching, dyspnea and chest tightness, angioedema during coronary artery stenting. Additional dose of i.v. methylpredinisolene 80 mg, salbutamol nebulae and i.v. adrenalin 1 mg administration rapidly stabilize the patients. All patients were successfully treated and uneventfully discharged after percutaneous coronary intervention.
Conclusion Management of patients with prior RCA adverse drug reaction may be complex. However when CAG and / or intervention is required in such patients it may be safely performed with premedication.

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