Comparative analysis of hypersensitivity reactions induced by three non-ionic iodine contrast media in percutaneous coronary intervention
10.3760/cma.j.cn114015-20200807-00852
- VernacularTitle:三种非离子型碘对比剂用于冠状动脉介入治疗致过敏反应发生情况的比较分析
- Author:
Juanjuan WEI
1
;
Yang LIN
1
;
Xiujin SHI
1
Author Information
1. 首都医科大学附属北京安贞医院药事部，北京 100029
- Publication Type:Journal Article
- Keywords:
Contrast media;
Percutaneous coronary intervention;
Anaphylaxis;
Iohexol;
Iopromide;
Iodixanol
- From:
Adverse Drug Reactions Journal
2021;23(2):63-68
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the occurrence and clinical characteristics of hypersensitivity reactions induced by 3 non-ionic iodine contrast media (NICMs) during percutaneous coronary intervention (PCI).Methods:The patients who developed hypersensitivity reactions in iopromide, iohexol, and iodixanol application during PCI were screened out from adverse drug reaction reports of Beijing Anzhen Hospital from January 1, 2013 to December 31, 2018 and the total number of patients who underwent the PCI during that period and received the above NICMs was obtained by searching the hospital information system. The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions and incidences of those induced by each of the 3 NICMs were calculated and their clinical characteristics were analyzed.Results:The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions induced by the 3 NICMs were 0.603% (422/69 955) and 0.024% (17/69 955). The incidences of hypersensitivity reactions induced by iohexol, iopromide, and iodixanol were 0.418% (109/26 097), 0.364% (83/22 787), and 1.092% (230/ 21 071), respectively; the incidences of severe hypersensitivity reactions were 0.023% (6/26 097), 0.039% (9/22 787), and 0.009% (2/21 071), respectively. Iodixanol had a higher incidence of hypersensitivity reactions than iopromide and iohexol (both P<0.001) but the lowest incidence of severe hypersensitivity reactions, which was significantly different from that of iopromide ( P=0.047). Of the 422 patients who developed hypersensitivity reactions, 327 were male and 95 were female with an average age of 59 years (range: 27-101 years). The time of hypersensitivity reactions occurrence was recorded in 373 patients and time from NICMs injection to hypersensitivity reactions occurrence were 30 minutes to 90 hours with the median time of 5 hours; hypersensitivity reactions were immediate type (latency ≤1 hour) in 127 patients (34.0%) and delayed type (latency>1 hour) in 246 patients (66.0%). The hypersensitivity reactions induced by iopromide were mainly immediate type (79.5%, 62/78), while those induced by ioxamol were mainly delayed type (87.7%, 193/220). The proportion of patients with a previous history of allergy in the immediate type patients was significantly higher than that in the delayed type patients [15.0% (15/100) vs. 7.1% (14/197), P=0.030]. The most common clinical manifestation of hypersensitivity reactions was rash [78.0% (329/422)]. Among 17 cases of severe hypersensitivity reactions, 15 (88.2%) were anaphylactic shock, 1 was laryngeal edema, and 1 was dyspnea, all of which were immediate type. Hypersensitivity reactions were all improved after treatments, but PCI failed to be fully performed in 6 patients due to severe hypersensitivity reactions. Conclusions:The safety of 3 NICMs for PCI was good and the incidence of hypersensitivity reactions was low; the incidence of severe hypersensitivity reactions due to iopromide was the highest. Severe hypersensitivity reactions such as anaphylactic shock might affect the performance of PCI and caution should be given.
