Anaphylactic shock with ioxaglate during coronary angiography: two cases.

Immediate reactions to raddio contrast media are rather well documented, but, their physiopathological mechanism (hypertonicity, direct histamine release from mast cells and basophils, complement activation, anaphylaxis), remains a debated question. The authors report two anaphylactic shocks (grade 3, classification of Ring and Messmer) during coronary angiography with ioxaglate. Anaphylaxis is suggested by clinical history: chronology of accidents, symptoms, strong positivity of intradermal tests for ioxaglate (diluted 1: 10000 and 1: 1000) and in one case, recurrence of the symptoms. It appears that an allergological control must be performed after a severe reaction with radio contrast media, in order to prevent the occurrence of further accidents. Premedication may only provide apparent safety: it did not prevent a severe reaction in one of the two cases. (C) 2002 Editions scientifiques et medicales Elsevier SAS.