Guideline 'Precautionary measures for contrast media containing iodine'

Annually, 0.5-1 million injections of contrast media containing iodine are administered in the Netherlands. Almost all contrast media nowadays are low-osmolar and nonionic. Nevertheless, the development ofcontrast-induced nephropathy is still a relevant clinical problem. Through an initiative by the Radiological Society of the Netherlands and with aid of the Dutch Institute for Healthcare Improvement (CBO), a guideline was conceived for the intravascular use of iodine-containing contrast media, based on recent scientific literature. The guideline defines the risk factors for contrast-induced nephropathy. One of the major risk factors is an impaired renal function. It is important to measure the glomerular filtration rate (GFR) in patients with a possible impaired kidney function, preferably by using the 'Modification of diet in renal disease' (MDRD)-study formula. The key measures for avoidance of contrast nephropathy are: limiting the amount of contrast agent used and to assure good hydration, by infusion of sodium chloride 0.9% 12-16 ml/kg body weight, both prior to and after contrast infusion. If time is limited, intravenous administration of sodium bicarbonate is an option. The guideline recommends discontinuation of metformin use from the day of contrast injection, if the GFR < 60 ml/min/1.73 m2, and to restart metformin 2 days following contrast infusion providing the GFR has not significantly deteriorated. Only in the case of previous moderate or severe adverse reactions to contrast media, prophylaxis with corticosteroids and antihistamines is recommended. Iodine allergy or an atopic condition is not a contraindication for the use of iodine-containing contrast media, and no prophylaxis is required. No specific measures are indicated in case of hyperthyroidism, acute pancreatitis, or phaeochromocytoma. Injection of contrast media is not contraindicated in case of pregnancy or lactation.     

A review of iodine toxicity reports

This article summarizes case reports, population studies, and experimental studies from the literature concerning adverse effects of exposure to iodine from the mid-1880s to 1988. Exposure to excessive iodine through foods, dietary supplements, topical medications, and/or iodinated contrast media has resulted in thyroiditis, goiter, hypothyroidism, hyperthyroidism, sensitivity reactions, or acute responses for some individuals. Reports of maternal iodine exposure during pregnancy or lactation affecting newborn or nursing infants are cited. Susceptibility to excess iodine is discussed as well as the relationship between dose and response. It is concluded that some individuals can tolerate very high levels of iodine with no apparent side effects and that iodine intakes less than or equal to 1.000 mg/day are probably safe for the majority of the population, but may cause adverse effects in some individuals. Determination of maximum tolerable levels of iodine intake will require human experimental studies at levels between 0.150 and 1.000 mg/day for normal subjects, subjects with autonomous thyroid tissue, and iodine-sensitive subjects.     

护理干预对静脉肾盂造影中碘对比剂不良反应发生的影响

目的探讨护理干预在静脉肾盂造影中减少碘对比剂不良反应的效果。方法将258例行静脉肾盂造影的患者,随机分为干预组（130例）和对照组（128例）,对照组采用常规护理,干预组在此基础上采用认知、心理、行为干预。结果干预组轻度不良反应57例（43.8%）,中度不良反应1例（0.8）,重度不良反应为0;对照组轻度不良反应86例（67.1%）,中度不良反应3例（2.3%）,重度不良反应为2（1.6%）。含碘对比剂不良反应发生率干预组明显低于对照组,差异有显著意义（P〈0.05）。结论适当的护理干预能有效地避免和降低碘对比剂不良反应的发生率,使病人能更为顺利地完成静脉肾盂造影检查。     

Iodine contrast in computed tomography: preventing adverse reactions

Computed tomography is an X-ray exam that has been widely indicated and chosen for diagnostic purposes, especially during the last few decades. However, although it is highly revealing, in several cases the procedure presents risks associated with exposure to radiation and to the iodine contrast medium. Few publications are available in the nursing literature regarding these issues. Therefore, a review of literature is presented, emphasizing exposure to iodine contrast and adverse reactions that may arise from its use. In addition, actions are described that can be taken by the health care team professionals to reduce the occurrence of such adverse events or minimize their severity.     

输血患者不良反应的临床特点及其相关影响因素分析

目的分析输血患者发生不良反应的临床特点,并对可能引起输血不良反应发生的相关因素进行探讨。方法2015年1月—2015年12月,安康市中心医院各临床科室3 127例输血患者为研究对象,对出现输血不良反应患者的输血类型、临床特点以及可能导致发生输血不良反应的相关因素进行分析。结果 3 127例输血患者输血不良反应发生率0.512%(16/3 127),其中过敏反应发生率0.352%(11/3 127)、发热反应发生率0.160%(5/3 127),无溶血反应发生,无其他不良反应发生;前三位发生输血不良反应的血液成分依次为机采血小板、红细胞悬液以及血浆,发生率分别为0.288%、0.160%和0.064%;且机采血小板输血不良反应发生率显著高于红细胞悬液和血浆输血不良反应发生率(P0.05);年龄小于18岁的患者、有输血史患者以及有过敏史患者输血不良反应发生率明显高于年龄18岁以上的患者、无输血史患者以及无过敏史患者,差异有统计学意义(P0.05);血液病组患者输血不良反应发生率显著高于非血液病组,差异有统计学意义(P0.05);儿童血液病区患者输血不良反应发生率显著高于输血科患者,差异有统计学意义(P0.05)。结论临床输血对年龄18岁、有输血史、有过敏史的患者进行输血治疗时应严密监视以防止输血不良反应的发生。积极使用白细胞过滤器有利于减少输血不良反应的发生。     

造影剂碘普罗胺在妇科盆腔CT检查中的效果及其安全性

目的 探究与分析造影剂碘普罗胺在妇科盆腔CT检查中的效果及其安全性.方法 运用回顾性研究方法,选取我院2018年2月-2021年1月收治的78例接受妇科盆腔CT增强检查者作为研究对象,观测全部患者的影像质量、全身及局部耐受性和相关不良反应.结果 在78例检查中,影像质量优良率为97.44％,患者耐受度为97.44％.患...     

接种抗狂犬病血清不良反应观察

目的观察抗狂犬病血清的皮肤过敏试验(皮试)阳性率和不良反应发生率,对指导使用抗狂犬病血清提供科学依据。方法按照抗狂犬病血清使用说明书,对被犬等动物咬伤Ⅲ级暴露者400人进行抗狂犬病血清皮肤过敏试验,并对380名接种抗狂犬病血清者观察不良反应。结果 400人抗狂犬病血清皮试阳性52例,阳性率13.00%;抗狂犬病血清全身反应发生率为1.05%,局部反应发生率为12.11%,皮试阳性和阴性者接种抗狂犬病血清不良反应发生率分别为12.50%和13.22%,差异无统计学意义(χ2=0.013,P﹥0.05)。全身反应和局部反应经及时对症处理0～5d治愈。结论接种抗狂犬病血清安全可行,但同时应做好抗狂犬病血清皮试、接种中观察及接种后观察处理工作。     

Food allergy: nuts and tree nuts

Nuts are a well-defined cause of food allergy, which affect approximately 1 % of the general population in the UK and the USA. There do appear to be differences in the frequency of nut allergy between different countries because of different dietary habits and cooking procedures. For example, in the USA and France, peanuts are one of the most frequent causes of food allergy, but in other countries, it seems to be less common. Genetic factors, in particular, appear to play a role in the development of peanut allergy. While the majority of nut allergens are seed storage proteins, other nut allergens are profilins and pathogenesis-related protein homologues, considered as panallergens because of their widespread distribution in plants. The presence of specific IgE antibodies to several nuts is a common clinical finding, but the clinical relevance of this cross-reactivity is usually limited. Allergic reactions to nuts appear to be particularly severe, sometimes even life-threatening, and fatal reactions following their ingestion have been documented. Food allergy is diagnosed by identifying an underlying immunological mechanism (i.e. allergic testing), and establishing a causal relationship between food ingestion and symptoms (i.e. oral challenges). In natural history investigations carried out in peanut-allergic children, approximately 20 % of the cases outgrew their allergy or developed oral tolerance. The treatment of nut allergies should include patient and family education about avoiding all presentations of the food and the potential for a severe reaction caused by accidental ingestion. Patients and families should be instructed how to recognise early symptoms of an allergic reaction and how to treat severe anaphylaxis promptly.     

Intravascular radiographic contrast media: issues for family physicians

BACKGROUND: Family physicians frequently order and in some instances supervise diagnostic tests using intravascular radiographic contrast media. METHODS: MEDLINE database was searched from 1966 to the present using the key terms "contrast media," "adverse reaction," "anaphylaxis," "anaphylactoid," "nephropathy," "renal failure," "kidney failure," and "MRI" in combinations. Other sources were found by back referencing these articles and in recent texts. RESULTS AND CONCLUSIONS: The adverse reactions likely to be encountered in most patients are acute anaphylactoid and cardiovascular reactions, delayed reactions, and renal effects. Mild acute reactions usually require no treatment, but if more severe reaction symptoms occur, emergency treatment is indicated. Acute reactions can be prevented or reduced by close attention to risk factors and pretreatment. Delayed reactions seldom require specific treatment. The type of contrast agent used might lessen the risk of immediate reactions. Contrast-associated nephropathy is most likely to occur in patients who have preexisting renal disease, heart failure, and volume depletion. Optimization of precontrast hydration can lessen the renal effects of contrast material. Magnetic resonance imaging contrast agents might be safer, because of smaller volumes administered, but adverse reactions have occurred.     

Adverse reactions and intracranial contrast medium after myelography

Correlation between adverse reactions and intracranial contrast media after myelography was studied. Myelography was carried out for 12 cases with metrizamide and 14 with iotrolan. In all patients, cranial CT scans were performed 18 approximately 22 hours after myelography. CT attenuation value of subarachnoid cistern was higher than the gray matter in 12 cases and lower in 14 cases. Six cases suffered from adverse reactions, but only 1 case belongs to the higher group. No correlation between adverse reactions and residual amount of contrast medium on CT was recognized.     

非离子造影剂碘海醇的不良反应

碘海醇为第二代非离子造影剂,这类造影剂通过降低渗透性,电性及化学毒性而降低造影剂的不良反应.临床广泛用于血管造影,腰、胸颈段及脊椎的造影,CT增强扫描等.这些造影剂比离子型造影剂较为安全,但是神经系统的不良反应时有发生,本研究给予综合报道.     

Food allergy and intolerance in children and adolescents, an update

Epidemiological surveys demonstrate that rapid increase in allergic diseases is a real phenomenon. In developed countries they are about the commonest chronic diseases, reaching between 15% and 30% of the population. Adverse reaction to food can be divided into toxic reaction and non-toxic reactions. The non-toxic reactions are divided into non-immune mediated and immune mediated, these are considered food allergic reactions. We showed our experience in a 4 y survey, individualized by food allergens during the first two years of life. In Spain egg white protein is the most common allergen followed by cow's milk and peanuts. These three food items represent half of the sensitizations in children under 2 y of age. After 4 y sensitivities to vegetable allergens such as nuts, fruits and legumes are most frequent. The diagnosis of food allergy is still problematic, even in the case of atopy or IgE mediated hypersensitivity. There is a lack of standardized diagnostic procedures; the only test accepted as 'gold standard' for confirmation of food allergy and in general for food intolerance, is a properly performed double blind placebo-controlled oral food challenge. Negative results should be always followed by an open food challenge. This test should only be conducted in patients with a good medical condition and in a clinic or hospital setting, and only if trained personal and equipment for treating systemic anaphylaxis are present. Contraindications to a challenge test are limited to those situations that can be hazardous for the patient in relationship to the studied food. The treatment of food allergy and intolerance is avoiding the implicated food as long as necessary, until tolerance appears. Prevention of food allergy is the first goal of every pediatric allergologist. Controlled trials of food allergy prevention have been performed only in high allergic risk children.     

碘造影剂在CT增强扫描中的护理体会

目的：探讨碘造影剂在CT增强扫描中的护理措施及护理效果。方法：选取600例需进行CT增强扫描的患者为研究对象,其中34例患者行常规护理（对照组）,566例患者在常规护理的基础上进行精细护理（观察组）,包括心理护理、静脉注药护理、过敏反应的预防和处理、造影剂渗漏的预防和处理。比较两组患者不良反应的发生情况。结果：观察组出现周身发热189例（33.39%）,感喉部烧灼紧束10例（1.77%）,12例（2.12%）出现轻度恶心、呕吐,12例（2.12%）扫描结束后出现局部皮肤瘙痒、荨麻疹样皮疹,10例（1.77%）患者发生渗漏,其中2例渗漏严重,导致扫描失败;其余注射顺利,全部患者无严重不良反应发生。对照组出现周身发热15例（44.12%）,感喉部灼烧紧束3例（8.82%）,3例（8.82%）患者出现轻度恶心、呕吐,4例（11.76%）扫描结束后出现局部皮肤瘙痒、荨麻疹样皮疹,2例（5.88%）患者扫描结束后出现全身皮肤瘙痒、荨麻疹,4例（11.76%）患者发生渗漏,均较严重致扫描失败;2例（5.88%）患者出现轻度耳、喉头水肿。观察组不良反应发生情况显著低于对照组,差异有统计学意义（P〈0.05）。结论：在CT增强扫描时采取精细护理能够有效降低不良反应的发生情况,利于CT增强扫描的顺利完成。     

Influence of dietary iodine on the iodine content of pork and the distribution of the trace element in the body

Background Millions of people worldwide still suffer from iodine deficiency disorders. Besides salt iodination, iodine is added to animal feed to concentrate it in food of animal origin (milk, eggs, meat). Otherwise possible adverse effects of high supplementation should be avoided. Aim of the study The objective of the study was to evaluate the iodine content of pork at various feed iodine concentrations to estimate its contribution to human iodine supply. Furthermore the handling of low and high iodine dosages by the organism should be investigated using the pig as a model for the human. Methods Seventy pigs (live weight period 27–115 kg), divided into five groups, were fed diets supplemented with 0 (group 1), 0.5 (group 2), 1 (group 3), 2 (group 4) and 5 (group 5) mg iodine per kg diet. Iodine was determined in the thyroid and in the fractions innards/blood, bones and muscle/fat of four pigs of each group by ICP-MS. Results Rising iodine supplementation of feed significantly increased (P < 0.05) the iodine content of the muscle/fat fraction [3.9 (group 1), 6.0 (group 2), 8.5 (group 3), 10.8 (group 4) and 17.1 (group 5) μg I/kg]. Carry over (of supplemented iodine) into muscle/fat varied between 0.10 and 0.24%. The highest tested iodine dosage (5 mg I/kg diet) caused a 3.6-fold iodine concentration of the total body (calculated from the contents of the fractions), and a significantly increased thyroid weight compared to the group without supplementary iodine. Iodine supplementation increased iodine content in thyroid and bones significantly (P < 0.05) but not in innards/blood. On an average of the groups, the thyroid contained 80% of the body’s iodine, innards/blood 14%, muscle/fat 5% and bones 1%. Conclusions The iodine content of pork, and consequently its contribution to human iodine supply (∼1%), is very low, even at high supplementation of feed. The total body iodine content (empty body) is determined by the iodine intake. Irrespective of the iodine dosage, the thyroid contains about 4/5 of the body iodine. Bones represent a very low iodine concentration, even at a strongly increased iodine intake. The increase of the thyroid weight as an adverse effect of iodine supplementation requires further research with high dietary iodine.     

Palladium--a review of exposure and effects to human health

Palladium is a metal the output and use of which has more than doubled in the past ten years. It is used in dental appliances, chemical catalysts, electrical appliances and jewellery, but the greatest increase in Pd demand has been in automotive emission control catalysts. Studies on Pd concentrations in ancient ice and recent snow samples reflect the increase in mining, smelting and use of palladium in the last decades. Increases of palladium in the environment have been shown in air and dust samples. There is no data as yet available to assess the effect of this exposure

A major source of health concern is the sensitization risk of Pd as very low doses are sufficient to cause allergic reactions in susceptible individuals. Persons with known nickel allergy may be especially susceptible. Workers occupationally exposed to Pd include miners, dental technicians and chemical workers. The latter are exposed mainly to Pd salts several of which may cause primary skin and eye irritations. It is advised that persons with known Pd allergy should not work with Pd compounds. The general population may come into contact with palladium mainly through mucosal contact with dental restorations and jewellery containing palladium and possibly via emissions from Pd catalysts. Protection of the public from related adverse effects may be achieved by the use of alloys with high corrosion stability and thus minimal release of palladium. In general, in dental patients who are sensitive to Pd, restorations using Pd-containing materials should not be used although Pd has been used without allergic effects in some of these individuals. Further, those patients who have an allergy to nickel should be informed that use of Pd-containing dental materials may cause Pd allergy, though this risk appears to be low.     

Gelatin-containing diphtheria-tetanus-pertussis (DTP) vaccine causes sensitization to gelatin in the recipients

Gelatin-specific T cell response was performed to determine whether a series of vaccinations with gelatin-containing DTP is a primary sensitization process in gelatin allergy. Thirty-seven recipients with gelatin-containing DTP who developed adverse reactions after vaccination and eight recipients of DTP without gelatin who also developed adverse reactions were studied. In addition, 10 subjects receiving gelatin-containing vaccine and 10 subjects inoculated with non-gelatin vaccine who did not show any adverse reactions were also investigated. All subjects inoculated with gelatin-containing DTP vaccine showed positive T cell responses against gelatin, however, occurrence of adverse reactions did not correlate with T cell responses. We conclude that DTP vaccine containing gelatin induces sensitization to gelatin in the recipients, but the mechanism of local reactions remains unknown.     

Adverse reactions to sulfa drugs: implications for malaria chemotherapy

National adverse drug reaction registers in Sweden and the United Kingdom provided data on the type, severity and frequency of reported adverse reactions attributed to sulfa drugs. Reactions to the ten principal drugs were examined in terms of their half-lives and usual indications for use. Of 8339 reactions reported between 1968 and 1988, 1272 (15%) were blood dyscrasias, 3737 (45%) were skin disorders, and 578 (7%) involved the liver. These side-effects occurred with all types of sulfa drugs investigated, although at different relative rates, and 3525 (42%) of them were classified as serious. The overall case fatality rate (CFR) was 1:15 serious reactions, and was highest in patients with white blood cell dyscrasias (1:7). Drugs with longer elimination half-lives had higher CFRs, particularly for fatalities after skin reactions. In Sweden, the estimated incidences of serious reactions were between 9 and 33 per 100,000 short-term users of sulfa drugs (two weeks), between 53 and 111 among those on malaria prophylaxis, and between 1744 and 2031 in patients on continuous therapy. For dapsone, the incidence appeared to increase with higher doses. Our results indicate that sulfa drugs with short elimination half-lives deserve to be considered for use in combination with proguanil or chlorproguanil for malaria chemotherapy and possibly prophylaxis. The smaller risk of adverse reactions associated with lower-dose dapsone suggests that it should also be evaluated as a potentially safe alternative.     

Reported adverse food reactions overestimate true food allergy in the community

OBJECTIVE: To determine the extent to which perceived adverse food reactions were associated with IgE mediated food allergy, as defined by skin prick testing (SPT). DESIGN: A cohort epidemiological study. Participants underwent SPT to five common food allergens (cow's milk, peanut mix, egg white, shrimp and whole grain wheat mix) and were asked whether they had ever suffered any food 'illness/trouble', and if so to list such food(s). A positive SPT was defined as wheal diameter of > or =3 mm. Cohen's kappa (kappa) was used to assess the agreement between SPT and self-reported reactions to food(s) which contained the allergen of interest. SETTING: Randomly selected adults who took part in the follow-up of the European Community Respiratory Health Survey (ECRHS) in 1998. SUBJECTS: The subjects were 457 adults aged 26-50 y. RESULTS: Fifty-eight (13%) adults were sensitised to at least one food allergen whilst 99 adults (22%) reported illness to food(s) nearly always. However, only seven subjects who reported illness to a food also had a positive SPT to the same food. The prevalence of adverse food reactions associated with IgE mediated allergy in the adult general population would be less than 1.5% (7/457). The agreement between SPT and self-reported illness to food(s) was poor for cow's milk (kappa=0) and wheat (kappa=0), slight for shrimp (kappa=0.16) and egg white (kappa=0.09) and fair for peanut mix (kappa=0.37). CONCLUSIONS: There was little agreement between self-reported perceived illness to food(s) known to contain the food allergen of interest, and positive SPT, suggesting that most reactions are not due to IgE mediated food allergy.