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From some research I just did for an essay.  Take it with however many grains of salt you wish.

Question 7:  What about the patient with a history of asthma - does that really increase the risk of anaphylaxis?

A history of multiple drug allergies or asthma is associated with a five-fold increased incidence of reactions to iodinated contrast materials; the rate for severe reactions increases from 0.02% to 0.1%.   However, no unique precautions are necessary, and most reactions in such patients will be minor.  There is no need to avoid a contrast exam.  But make sure an asthmatic has a beta-agonist inhaler at hand.

Conclusion:  A prior history of asthma or multiple allergies is no reason to withhold contrast material or begin a long prophylaxis protocol.  Be aware there is a 1-in-a-1000 chance the patient will develop a severe reaction, which can be treated like any other anaphylactic reaction.

Morcos SK.  Review article: Acute serious and fatal reactions to contrast media: our current understanding.  Br J Radiol.  2005 Aug;78(932):686-93.  


Joe Lex
Philadelphia

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> Is it generally accepted that Asthamtic children who require a CT with IV 
> contrast are required to go through a pre treatment protocol including 
> Diphenhydramine and Steroids? Does it depend on recent vs remote last 
> exacerbation? 
> Is anyone willing to share their protocols? 
> Thanks. 
> 
> Elliott Friedman, MD 
> New York 
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