101:
Risk Factors for Anaphylactoid Reaction to Low Osmolar Contrast During Cardiac Catheterization
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Martin A Smith, MD, Lisanne P. Newton, MD, David Newton, MD, Leslie Cho, MD, Maria A. Barcena Blanch, MD, Lyda Cuervo Pardo, MD, Xiaofeng Wang, Manshi Li, David M. Lang, MD FAAAAI
RATIONALE:

Beta blockers(BB) have been associated with increased risk for severe anaphylactoid reaction(AR) from contrast media(CM); however, this was shown with intravenous CM(Arch Intern Med 1993;153:2033), prior to widespread use of low osmolar contrast media(LOCM), ACE inhibitors(ACE-I) and cardioselective BB. We assessed risk for AR with cardiac catheterization(CC) associated with BB or ACE-I exposure.

METHODS:

Patients who experienced adverse reactions during CC from January 2004-December 2013 were identified; 1-2 matched controls were assigned for each case. We analyzed AR rates in association with demographic variables, medication exposures (BB, ACE-I, Angiotensin receptor blockers, aspirin) and co-morbidities: cardiovascular disorders(CVD), asthma, atopy.

RESULTS:

We analyzed 71,782 CCs. Of these, severe 70 reactors were identified- 46 (0.06%) fulfilled AR criteria. There were 35 mild-moderate and 11 severe AR (0.015%). There were no significant differences in age (61.3% vs 61.5%), gender (63% vs 64% male), CVD rate (78% vs 93%), exposure to BB (46% vs 51%, cardioselective: 81% vs 80%) and ACE-I (37.0% vs 37.2%) in cases vs. controls. Via multivariate logistic regression, BB exposure was not associated with greater AR frequency(p=0.35) or severity (p=0.40). Neither cardioselective BBs (p= 0.2) nor non-cardioselective BB (p=0.5) influenced AR severity. ACE-I had no effect on AR frequency (p=0.35) or severity (p=0.14). Lower AR frequency was associated with CVD (p=0.01).

CONCLUSIONS:

In this case control-study, severe AR were rarely observed. Exposure to BB or ACE-I did not significantly influence AR frequency or severity; however, most BB were cardioselective. Our findings imply cardioselective BB or ACE-I suspension is not warranted in association with CC.