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When Premedication Fails: Anaphylaxis to Iodinated Contrast Media in the Cardiac Catheterization Lab Despite
Anthony T Trinh1, Jeremy C McMurray2, Luke M Pittman3
1Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA; Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
JACC. Case Reports
|August 15, 2025
Summary
Severe allergic reactions to iodinated contrast media (ICM) can occur, even with premedication. Allergy testing can identify safe alternative agents for future procedures.
Area of Science:
- Cardiology
- Allergy and Immunology
Background:
- IgE-mediated anaphylaxis to iodinated contrast media (ICM) is a rare but serious complication.
- These reactions are often refractory to standard premedication protocols like corticosteroids and antihistamines.
Observation:
- A patient with a history of severe anaphylaxis to a specific ICM agent experienced a hypotensive reaction despite premedication during coronary angiography.
- The patient underwent allergy evaluation, including skin testing, which identified a safe alternative contrast agent.
Findings:
- Skin testing by an allergy specialist successfully identified an alternative ICM agent that the patient could tolerate.
- This allowed for the successful completion of percutaneous coronary intervention.
Implications:
- Current cardiovascular angiography guidelines offer limited advice for managing recurrent, severe ICM reactions.
- Allergy consultation and targeted skin testing are crucial for selecting safe alternative agents in suspected IgE-mediated ICM reactions, enabling necessary contrast-enhanced procedures.
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