Risk factors for adverse reactions from contrast agents for computed tomography

Research article

Risk factors for adverse reactions from contrast agents for computed tomography

Daiki Kobayashi^1*, Osamu Takahashi², Takuya Ueda³, Gautam A Deshpande^4,5, Hiroko Arioka² and Tsuguya Fukui²

• *Corresponding author: Daiki Kobayashi daikoba@luke.or.jp

Author Affiliations

¹Division of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital, Tokyo, Japan

²Division of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

³Department of Radiology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

⁴St. Luke’s Life Science Institute, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

⁵Department of Internal Medicine, University of Hawaii, Honolulu, HI, Hawaii

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BMC Medical Informatics and Decision Making 2013, 13:18 doi:10.1186/1472-6947-13-18

The electronic version of this article is the complete one and can be found online at:http://www.biomedcentral.com/1472-6947/13/18

Received:	16 July 2012
Accepted:	21 January 2013
Published:	30 January 2013

© 2013 Kobayashi et al.; licensee BioMed Central Ltd. 

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Symptoms of an adverse reaction to contrast agents for computed tomography are diverse ranging, and sometimes serious. The goal of this study is to create a scoring rule to predict adverse reactions to contrast agents used in computed tomography.

Methods

This was a retrospective cohort study of all adult patients undergoing contrast enhanced CT scan for 7 years. The subjects were randomly divided into either a derivation or validation group. Baseline data and clinically relevant factors were collected from the electronic chart. Primary outcome was any acute adverse reactions to contrast media, observed for during 24 hours after administration. All potential candidate predictors were included in a forward stepwise logistic regression model. Prediction scores were assigned based on β coefficient. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) and incidence of acute adverse reactions at each point were obtained. The same process was performed in the validation group.

Results

36,472 patients underwent enhanced CT imaging: 20,000 patients in the derivation group and 16,472 in the validation group. A total of 409 (2.0%, 95% CI:1.9-2.3) and 347 (2.1%, 95% CI:1.9-2.3) acute adverse reactions were seen in the derivation and validation groups. Logistic regression analysis revealed that prior adverse reaction to contrast agents, urticaria, an allergic history to drugs other than contrast agents, contrast agent concentration >70%, age <50 agent="" and="" contrast="" dose="" total="" years="">65 g were significant predictors of an acute adverse reaction. AUC was 0.70 (95% CI:0.67-0.73) and 0.67 (95% CI:0.64-0.70) in the derivation and validation groups.

Conclusions

We suggest a prediction model consisting of six predictors for acute adverse reactions to contrast agents used in CT.

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First case of taurine-containing drink induced anaphylaxis

Case Report  Open Access  |  | Full Text    |    Asia Pac Allergy. 2013 Jan;3(1):70-73. English. Published online 2013 Jan 30.  http://dx.doi.org/10.5415/apallergy.2013.3.1.70  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. A case of taurine-containing drink induced anaphylaxis Seung-Eun Lee,1,2,3 Suh-Young Lee,1,2,3 Eun-Jung Jo,1,2,3 Mi-Young Kim,1,2,3 Min-Suk Yang,1,2,4 Yoon-Seok Chang,1,2,3 and Sae-Hoon Kim1,2,3 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea. 2Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-802, Korea. 4Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul 156-707, Korea.  Correspondence: Sae-Hoon Kim. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 463-802, Korea. Tel: +82-31-787-7046, Fax: +82-31-787-4052,Email: shkrins@gmail.com  Received December 11, 2012; Accepted December 19, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks. The patient also showed positive response with synthetic taurine but not with natural taurine. Skin prick test and basophil activation test with the synthetic taurine were negative. To our knowledge, there has been no report of taurine-induced hypersensitivity reactions. We herein report the first case of taurine-containing drink induced anaphylaxis, especially by synthetic taurine.

The influence of sensitisation to pollens and moulds on seasonal variations in asthma attacks

1. C. Canova*, 
2. J. Heinrich#, 
3. J.M. Anto¶,+,§,f, 
4. B. Leynaert**, 
5. M. Smith##,
6. N. Kuenzli¶¶,++, 
7. J.-P. Zock¶,+,§, 
8. C. Janson§§, 
9. I. Cerveriff,
10. R. de Marco***, 
11. K. Toren###, 
12. T. Gislason¶¶¶, 
13. D. Nowak+++, 
14. I. Pin§§§,
15. M. Wjstfff, 
16. J. Manfreda****, 
17. C. Svanes####, 
18. J. Crane¶¶¶¶,
19. M. Abramson++++, 
20. M. Burr§§§§, 
21. P. Burney* and 
22. Deborah Jarvis*⇓

+Author Affiliations

1. ^*Respiratory Epidemiology and Public Health and MRC-HPA Centre for Environment and Health, National Heart and Lung Institute, Imperial College, London, UK
2. ^#Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
3. ^¶Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
4. ⁺Hospital del Mar Research Institute (IMIM), Barcelona, Spain
5. ^§CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
6. ^fDept of Life and Experimental Sciences, Universitat Pompeu Fabra, Barcelona, Spain
7. ^**National Institute of Health and Medical Research, INSERM Unit 700, Paris, France
8. ^##Medical University of Vienna, Dept of Oto-Rhino-Laryngology, Research Unit Aerobiology and Pollen information, Vienna, Austria
9. ^¶¶University of Basel, Basel, Switzerland
10. ⁺⁺Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
11. ^§§Dept of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
12. ^ffClinica di Malattie dell'Apparato Respiratorio, Fondazione Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Università di Pavia, Pavia, Italy
13. ^***Unit of Epidemiology and Medical Statistics, Dept of Medicine and Public Health, University of Verona, Verona, Italy
14. ^###Section of Occupational and environmental medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
15. ^¶¶¶Faculty of Medicine, University of Iceland, Iceland
16. ⁺⁺⁺Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
17. ^§§§CHU de Grenoble; INSERM, U823, Institut Albert Bonniot, University Joseph Fourier, Grenoble, France
18. ^fffInstitute of Lung Biology and Disease, CPC - Comprehensive Pneumology Center, Helmholtz Center Munich - German Research Center for Environmental Health, Munich, Germany
19. ^****Dept of Medicine, University of Manitoba, Winnipeg, Canada
20. ^####Institute of Medicine, University of Bergen, Bergen, Norway
21. ^¶¶¶¶Wellington Asthma Research Group, University of Otago, Wellington, New Zealand
22. ⁺⁺⁺⁺Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
23. ^§§§§Dept of Primary Care and Public Health, Cardiff University, Cardiff, UK

1. Deborah Jarvis, MBBS MRCP MD FFPHM, Respiratory Epidemiology and Public Health, Imperial College, London, Emmanuel Kaye Building, Manresa Road, London. SW3 6LR, E-mail: d.jarvis@imperial.ac.uk

Abstract

No large study has described seasonal variation in asthma attacks in population based asthmatics in whom sensitisation to allergen has been measured.

2,637 young adults with asthma living in 15 countries reported months in which they usually had attacks of asthma and had skin prick tests performed. Differences in seasonal patterns by sensitisation status were assessed using generalised estimating equations.

Most young adults with asthma reported periods of the year when their asthma attacks were more common (range 47% in Sweden to 86% in Spain). Seasonal variation in asthma was not modified by sensitisation to house dust mite or cat. Asthmatics sensitised to grass, birch and Alternaria had different seasonal patterns to those not sensitised to each allergen, with some geographical variation. In Southern Europe, those sensitised to grass were more likely to report attacks occurred in spring/summer than in winter (ORMarch/April=2.60; 95%CI 1.70–3.97; ORMay/June=4.43; 95%CI 2.34–8.39) and smaller later peaks were observed in Northern Europe (ORMay/June=1.25; 95%CI 0.60–2.64; ORJuly/August1.66; 95%CI 0.89–3.10). Asthmatics reporting hayfever but who were not sensitised to grass showed no seasonal variations.

Seasonal variation in asthma attacks in young adults is common and is different depending on sensitisation to outdoor, but not indoor, allergens.

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This Article

1. Published online before print March 7, 2013, doi:10.1183/09031936.00097412ERJ March 7, 2013erj00974-2012

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