D3.340 - The importance of de-labeling contrast allergy în cardiology department - clinical case

Intravenous iodinated contrast media (e.g., iohexol, iopromide) is widely used across the world. Iodinated contrast media are the standard, indispensable agents used in coronaro-angiography. Non-ionic low-osmolar or iso-osmolar agents are preferred. Hypersensitivity reactions to contrast agents, although rare, are sometimes present. Hypersensitivity reactions can be immediate or delayed, mild (urticaria), to severe (angioedema, anaphylaxis or anaphylactic shock). Incorrect labeling of hypersensitivity reactions to drugs may deprive patients of some essential treatments or procedures.

We present the case of a 75-year-old female patient with ischemic heart disease, angina pectoris, and severe stenosis of the coronary arteries (75-90% of the coronary lumen). During coronary angiography with contrast medium (iohexol), the patient developed bronchospasm and skin hyperemia, without hypotension or other symptoms. These manifestations were interpreted by the cardiologist as iohexol anaphylaxis, and the procedure was interrupted without performing stent revascularization. The patient was admitted to intensive care for 24 hours, then discharged and sent for allergological evaluation, being refused by the cardiologist for a new attempt at coronary revascularization. The patient presents with a negative basophil activation test to iohexol. Skin prick tests were performed with iohexol and iopromide (concentration 1/1 for prick and 1/10 for intradermic) which were negative at 30 and 60 minutes and 24 hours. Five days later, coronary revascularization was performed on three coronary arteries, using the same contrast medium as in the first intervention (iohexol), without adverse events or hypersensitivity. Mislabeling symptoms during coronary angiography as anaphylaxis and avoiding interventional coronary revascularization treatments may expose patients to increased cardiovascular risks. Patients with 75-90% coronary stenosis have a major risk of acute myocardial infarction. De-labeling in correct allergological work-up with basophil activation tests and skin tests provides safety for patients and cardiologists.