Clinical Features and Treatment Patterns of Radiocontrast Mediainduced Anaphylaxis in the Emergency Department

Kim,  Hahn Bom; Kim,  Do Kyun

J Korean Soc Emerg Med > Volume 20(6); 2009 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2009;20(6): 709-714.

Clinical Features and Treatment Patterns of Radiocontrast Mediainduced Anaphylaxis in the Emergency Department

Hahn Bom Kim, Do Kyun Kim

Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea. birdbeak@naver.com

ABSTRACT

PURPOSE:
With the advances in diagnostic and interventional radiology, emergency physicians have been frequently confronted with radiocontrast media (RCM)-induced anaphylaxis. However, few studies have addresses RCMinduced anaphylaxis in Korea. The aim of this study was to describe the clinical features and treatment patterns of RCM-induced anaphylaxis patients who visited an emergency department (ED) in a tertiary referral hospital.
METHODS:
All patients who visited the ED and were diagnosed with "anaphylaxis" during a 3-year period were evaluated and cases of RCM-induced anaphylaxis were selected based on medical records.
RESULTS:
Twenty patients with RCM-induced anaphylaxis were retrospectively analyzed. Nine patients (45.0%) were male and the mean age was 59.5+/-14.9 years. Eighteen patients were referred following computed tomography (CT) examination and 2 patients from home. The most common manifestations were systolic blood pressure (SBP) < 90 mmHg (75.0%), followed by dizziness (55.0%), syncope (40.0%), angioedema (35.0%), and dyspnea (35.0%). Epinephrine was administered in 16 patients (80.0%), corticosteroids in 18 (90.0%), and antihistamine in 18 (90.0%). Only 4 patients (22.2%) were managed by epinephrine in the CT room. Seventeen patients were discharged directly from the ED after some observation period (7.3+/-5.0 hours) and 3 were admitted to the ICU. Corticosteroids were prescribed at discharge only in 9 patients (45.0%).
CONCLUSION:
The clinical features of RCM-induced anaphylaxis were similar to those of other causative agents. The underuse of epinephrine in the CT room and the under-prescription of corticosteroids at discharge indicate a need for anaphylaxis management education and treatment plan.

Key words: Contrast media, Anaphylaxis, Epinephrine