iothalamate-meglumine and Anaphylaxis

To extent the safety information for Chymodiactin (chymopapain for injection), 37 neurologic and orthopedic surgeons conducted an open-label, multicenter, phase 3 clinical study. A total of 1,498 patients with one or two herniated lumbar intervertebral discs were enrolled. Therapeutic results were generally favorable, with the percentages of patients achieving either excellent or good (or successful) results ranging from 79.6% to 88.9%, depending on criteria employed in the tabulation. There were 13 cases of anaphylaxis, and 2 of these patients died of complications of anaphylaxis. Two additional patients experienced serious neurologic problems. The first of these two patients developed transverse myelitis and paraplegia approximately 3 weeks following chemonucleolysis. Transdural discograms at three levels had been done approximately 2 days prior to chemonucleolysis, in violation of the protocol. The second patient developed acute cauda equina syndrome, and, despite emergency laminectomy, had permanent neurologic sequelae. Back spasm and stiffness/soreness were the most frequently encountered adverse experiences.

Topics: Adolescent; Adult; Anaphylaxis; Chymopapain; Clinical Trials as Topic; Double-Blind Method; Endopeptidases; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Middle Aged; Radiography; Random Allocation; Spasm

Severe anaphylaxis to contrast media used in hysterosalpingography is very rare. Leukopenia may sometimes be seen in severe anaphylaxis associated with shock. This case report is about an atypical presentation of anaphylaxis following the injection of Conray 280 for hysterosalpingography. The patient had severe leukopenia without other associated features of anaphylaxis that resolved spontaneously after 48 h. This type of reaction to Conray 280 has not been reported before.

Topics: Adult; Anaphylaxis; Contrast Media; Female; Humans; Hysterosalpingography; Infertility, Female; Iothalamate Meglumine; Leukopenia; Severity of Illness Index

Topics: Anaphylaxis; Animals; Blood Pressure; Contrast Media; Drug Hypersensitivity; Homeostasis; Iothalamate Meglumine; Lethal Dose 50; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Rats; Rats, Inbred BN; Rats, Sprague-Dawley

We assessed the role that nitric oxide (NO) plays in contrast media (CM) toxicity, using 100% lethal dose (LD100) studies in hyperimmune Brown Norway (BN) rats.. Ninety-two BN rats and 41 Sprague-Dawley (SD) rats underwent CM LD100 tail vein injections with methylglucamine iothalamate or sodium iothalamate to the point of cessation of respiration. Methylglucamine hydrochloride also was injected. The injections were accompanied by L-arginine (L-Arg) or D-arginine (D-Arg) analogues or by an H1 blocker. L-Arg analogues inhibit NO formation, and D-Arg analogues do not.. An L-Arg analogue, but not a D-Arg analogue, increased the tolerance of BN rats (p < .005) for methylglucamine iothalamate but not for sodium iothalamate. The L-Arg analogue also protected BN rats against methylglucamine chloride injections (p < .002). H1 blockade protected BN rats against methylglucamine iothalamate (p < .0005) and methylglucamine chloride (p < .005) injections. None of these measures altered the CM tolerance of SD rats. In SD rats, injections of either methylglucamine iothalamate or sodium iothalamate along with a D-Arg analogue or normal saline were better tolerated than similar injections in BN rats (p < .01 and .002 for methylglucamine iothalamate and sodium iothalamate, respectively). In SD rats but not BN rats, sodium iothalamate was better tolerated than was methylglucamine iothalamate (p < .0005).. NO appears to play a significant role in BN rats LD100 CM toxicity and has been implicated by others in the blood pressure fall characterizing some forms of antigen-induced anaphylaxis [1, 2]. The results of the current study and the literature suggest that methylglucamine-modulated release of histamine from mast cells may underlie the NO production.

Topics: Anaphylaxis; Animals; Contrast Media; Drug Interactions; Enzyme Inhibitors; Histamine H1 Antagonists; Injections, Intravenous; Iothalamate Meglumine; Iothalamic Acid; Lung; Male; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; omega-N-Methylarginine; Rats; Rats, Inbred BN; Rats, Sprague-Dawley

Topics: Adult; Anaphylaxis; Asthma; Humans; Iothalamate Meglumine; Male; Nasal Polyps; Radiography

A rare case of anaphylaxis to iodinated contrast media is reported. The patient underwent two anaphylactic shocks to intravenous administration of radiocontrast agents. Specific IgE were suspected on the basis of positivity of intradermal tests and human basophil degranulation tests. The passive sensitization of basophils from donors was performed, comparing native and heated serum. Results agreed with the hypothesis of IgE antibodies, since heating 56 degrees C during two hours prevented the degranulation. Considering the chemical structure, iopamidol was thought to be innocuous. Two opacification procedures were further performed with iopamidol without any incident.

Topics: Aged; Anaphylaxis; Basophil Degranulation Test; Complement Activation; Contrast Media; Diatrizoate Meglumine; Drug Hypersensitivity; Heart Arrest; Humans; Immunoglobulin E; Intradermal Tests; Iothalamate Meglumine; Male; Molecular Structure; Preoperative Care

Topics: Anaphylaxis; Brain; Child; Epilepsies, Myoclonic; Humans; Iothalamate Meglumine; Male; Tachycardia; Tomography, X-Ray Computed

Topics: Adult; Anaphylaxis; Female; Humans; Iothalamate Meglumine; Pulmonary Edema

A case of severe anaphylactoid reaction following injection of intravenous contrast is described, and a discussion of the treatment of severe allergic reactions follows. The patient's presentation was unusual in that she rapidly developed massive non-cardiac pulmonary edema as the primary symptom, along with hypotension and hypokalemia, a syndrome similar to adult respiratory distress syndrome. The development of the reaction along with the unusual presentation is discussed and a detailed discussion of the generalized treatment of anaphylactoid and anaphylactic reactions is presented. Additionally, several errors in management that may have delayed resolution of the symptoms and prolonged the period of instability in the patient's condition are discussed and critiqued.

Topics: Acute Disease; Anaphylaxis; Critical Care; Drug Therapy, Combination; Female; Humans; Hypokalemia; Hypotension; Iothalamate Meglumine; Middle Aged; Pulmonary Edema

The occurrence of an anaphylactoid shock in a patient treated with beta-adrenergic blocking agents during a long time prior to surgery constitutes a high risk because beta-receptors are refractory to adrenergic substances and compensatory mechanisms are obtunded. The shock is characterized by severe hypotension and bradycardia, both resistant to adrenaline. These signs were observed in a patient treated with metoprolol for hypertension several months prior to surgery. The intravenous injection of an iodine containing contrast medium during general anaesthesia was followed by a lethal anaphylactoid shock resistant to adrenaline, atropine and isoprenaline. The treatment of the shock needs, besides adrenaline, massive vascular filling, high doses of beta-agonists and glucagon.

Topics: Adrenergic beta-Antagonists; Anaphylaxis; Anesthesia, General; Blood Pressure; Contrast Media; Humans; Hypertension; Iothalamate Meglumine; Male; Middle Aged

One hundred randomly selected patients undergoing routine excretory urography were assigned in double-blind fashion by alternate entry pairs to receive radiographic contrast media at 37 degrees C (Group I) or room temperature (Group II). There were three anaphylactoid reactions and five nonanaphylactoid reactions in Group I, and five anaphylactoid and eight nonanaphylactoid reactions in Group II, differences that were not statistically significant. No differences were detected between reactors and nonreactors. Thus, in this study, infusion temperature had no effect on the frequency of adverse reactions to radiographic contrast media during excretory urography.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Contrast Media; Double-Blind Method; Female; Humans; Infusions, Parenteral; Iothalamate Meglumine; Male; Middle Aged; Random Allocation; Temperature; Urography

Topics: Adult; Anaphylaxis; Humans; Iothalamate Meglumine; Male; Tomography, X-Ray Computed

A critical literature review is presented on the basis of our own clinical experiences with complications and distressing side effects of the lumbar Dimer-X myelography. Severe Complications such as spinal and conuscauda-symptoms, epileptic seizures, amnestic episodes and late palsies of the Abducens nerve in literature range between 1 and 9%. Unspecific side effects which cannot clearly be differentiated from pure post-lumbal puncture complaints are reported to occur in up to 28%. The probably underlying pathogenetic mechanisms are discussed together with former animal experiments which revealed a local toxity of the contrast medium at the central nervous tissue and the surrounding membranes.

Topics: Abducens Nerve; Anaphylaxis; Epilepsy; Humans; Iothalamate Meglumine; Lumbosacral Region; Myelography; Paralysis; Spinal Cord Diseases

Topics: Anaphylaxis; Contrast Media; Humans; Infusions, Parenteral; Injections, Intra-Arterial; Injections, Subcutaneous; Iothalamate Meglumine; Male; Middle Aged