Renal arteriography following systemic reaction to contrast material

A 15-year-old atopic female with severe hypertension (B.P. 220/160) was evaluated for evidence of renal arterial disease with equivocal results, and the performance of renal arteriography was considered essential. However, she had a history of two well-documented anaphylaxis-like reactions to contrast materials, considered to be an absolute contraindication to the performance of such a study. When the etiology of this sensitivity was investigated, an IgE-dependent mechanism was not evident. However, the patient's leukocytes released significantly greater quantities of histamine upon incubation with contrast materials than did 7 of 9 normal volunteers. The 2 hyperresponsive normal subjects were not atopic and had no prior exposure to contrast materials. Pretreatment with 80 mg prednisone and 200 mg diphenhydramine daily for 3 days prior to arteriography and challenge with increasing quantities of intravenous iothalamate meglumine (Conray) at the time of the study resulted in successful performance of arteriography and identification of fibromuscular dysplasia of the right renal artery. Placement of an aortorenal bypass graft corrected her hypertension. Thus, arteriography can be safely performed in selected patients with severe previous reactions to contrast materials when the alternatives provide no lesser risk by pretreatment with a steroid-antihistamine regimen and gradual administration of increasing doses of the contrast agent.