A case of anaphylactoid reaction to nonionic radiocontrast media iopromide (Ultravist) / 천식및알레르기

Because the risk of adverse reactions is lower with nonionic radiocontrast media than with conventional ionic agent, it is recommended that high-risk patients receive lower osmolality, a nonionic radiocontrast for their examination. However, the occurrence of a severe, life-threatening anaphylactoid reaction to even a small dose of nonionic radiocontrast has been reported. We report the first case in Korea of near-fatal anaphylactoid reaction to a nonionic contrast media. A 21-year-old lady with an abdominal mass due to benign mucinous cystadenoma received an injection of iopromide (Ultravist ) for abdominal computerized tomogram. Two minutes after the injection, perioral swelling and erythema, vomiting, seizure, and cardiopulmonary arrests developed. Immediate cardiopulmonary resuscitation and administrations of antihistamine, steroid, and sympathomimetics were performed with successful recovery. She had a history of allergic rhinitis and showed mild airway hyperresponsiveness on histamine bronchoprovocation test. Since a pretreatment with corticosteroid & antihistamine regimen in addition to use of nonionic agent helped to reduce the further occurrence of anaphylactoid reactions in previous contrast reactors, this near-fatal anaphylactoid reaction in an atopic individual suggests that a use of pretreatment plus nonionic agent is desirable in all patients with atopy or asthma.

Clinical significance of forced expiratory wheezing in chronic airflow obstruction / 천식및알레르기

BACKGROUND: Wheezing which is defined as a continuous sound with a musical quality is commonly auscultated in patients with chronic obstructive airway diseases. The correlation between wheezing and airway obstruction is unclear. OBJECTIVE: This study was designed to evaluate the relationships among wheezing, severity of airway obstruction, and pulmonary function tests. METHOD: Forty-one subjects were examined by the same observer. Wheezing during normal breathing and maximal forced exhalation, was auscultated respectively. Posterior lung bases were auscultated bilaterally with the seated patient taking repeated inspiratory capacity breaths through an open mouth. To quantify wheezing intensity, a regional score was assigned for each area after a minimum of 3 breaths, according to the following scale: zero, no wheezing heard: one, faint or intermittent wheezes: two, moderate wheezing during every expiration: three, loud wheezing during every expiration. The lung function tests by standard pneumotachograph were performed by skilled technicians. RESULTS: Wheezing was auscultated more in forced exhalation than in normal breathing in patients with asthma and COPD [8/9(88%) vs 1/9(11%), p<0.01 ll/15(73%) vs 1/15(6%), p<0.05)]. Forced expiratory wheezes group (n=25) compared to no wheezes group (n=16) had significantly lower FEVl (75+-5.8% vs 95.6+-6.6%, p<0.05). Compared to no wheezes group, the group with forced expiratory wheezes had lower FEV1 and FEV1/FVC (50.4+- 21.3% vs 81.15+-27.7%, 70.4+-22.4% vs 92.5+-19.3%, respectively, p<0.05). Bronchial asthma compared with COPD tended to have higher wheezing scores (Wheeze scores Bronchial asthma 3.5 vs COPD 2.4, p=0.08). Wheezing scores were correlated to FEV1 (normal breathing: r=-0.35, p<0.05: forced exhalation: r=-0.45, p<0.05), but no differences were found in wheezing incidence according to severity of airway obstruction. CONCLUSION: These findings suggest that wheezing on maximal forced exhalation may be a useful physical indicator for evaluating the severity of airway obstruction.