Severe allergic reaction to contrast dye during emergent coronary angiogram

We present a case of a middle-aged woman with an extensive history of adverse reactions to iodinated contrast media (ICM) despite premedication. The patient presented from an outside hospital with an ST elevation myocardial infarction in the inferior and anterior leads. She received thrombolytics and was transferred to our hospital. Due to persistent chest pain and ST elevations consistent with failure of reperfusion with thrombolytics, we elected to pursue emergent catheterisation. Despite administration of intravenous glucocorticoid and diphenhydramine at our hospital, the patient had an anaphylactoid reaction during the procedure that was refractory to epinephrine and required intubation and pressor support. We suspect that earlier administration of premedication, especially glucocorticoids, prior to transfer may have improved our patient's outcome. This case report highlights the importance of vigilance in considering anaphylaxis and the potential role of early administration of premedication in patients with previous ICM reactions to minimise risk of recurrent adverse reactions.