PDF(Pubmed)
Abstract：
UNASSIGNED: Although several studies deal with breakthrough reactions (BTRs) in patients with contrast media (CM) hypersensitivity reactions, the phenomenon is still unclear. Therefore, this study aimed to analyse in depth patients with BTR in two countries.
UNASSIGNED: We retrospectively analysed the electronic medical records of in- and outpatients (random sample enrolment) from two academic hospitals of tertiary care (Seoul/South Korea, with a special monitoring system exclusively for CM hypersensitivity, and Bern/Switzerland, manually operated) with respect to basic epidemiological data, number of BTRs per patient, and severity grades of severity in follow-up analyses. The study period lasted from 2013 (2000 Bern) to 2017.
UNASSIGNED: We identified 445 BTR-patients (91.5% from Seoul) with 691 BTRs (94.5% from Seoul). Most reactions were mild, 11% moderate and 3.9% severe. In Seoul, we found patients with up to 10 BTRs, and in Bern, there were only patients with one BTR. Fatal reactions or deaths did not occur. In most cases, the severity of the BTRs and of the index reactions were identical (80.8%). Mild index reactions remained constant in 90.6%. In contrast, in moderate index reactions the severity decreased/remained identically in 86.8% and increased in 13.2%. In severe index reactions, 55.6% of BTR reactions were severe again, in 44.4% the severity decreased. In 158 BTRs (22.9%) the culprit iodinated contrast medium (ICM) of the index reaction induced the BTR. In the other 482 BTRs (69.8%) the culprit ICM was changed to another non-culprit ICM.
UNASSIGNED: To the best of our knowledge, this is the largest study on patients with BTRs, and the first study showing BTRs in two centers in two countries of two continents. The main differences between the two centers result from the different hospital size, the number of patients, and the different documentation [manual (Bern) vs. electronical screening (Seoul)]. BTRs are no contraindications for further ICM-application. We recommend performing an allergy skin test as basis for the decision-making process of the next contrast-enhanced image-guided examination.
UNASSIGNED: We retrospectively analysed the electronic medical records of in- and outpatients (random sample enrolment) from two academic hospitals of tertiary care (Seoul/South Korea, with a special monitoring system exclusively for CM hypersensitivity, and Bern/Switzerland, manually operated) with respect to basic epidemiological data, number of BTRs per patient, and severity grades of severity in follow-up analyses. The study period lasted from 2013 (2000 Bern) to 2017.
UNASSIGNED: We identified 445 BTR-patients (91.5% from Seoul) with 691 BTRs (94.5% from Seoul). Most reactions were mild, 11% moderate and 3.9% severe. In Seoul, we found patients with up to 10 BTRs, and in Bern, there were only patients with one BTR. Fatal reactions or deaths did not occur. In most cases, the severity of the BTRs and of the index reactions were identical (80.8%). Mild index reactions remained constant in 90.6%. In contrast, in moderate index reactions the severity decreased/remained identically in 86.8% and increased in 13.2%. In severe index reactions, 55.6% of BTR reactions were severe again, in 44.4% the severity decreased. In 158 BTRs (22.9%) the culprit iodinated contrast medium (ICM) of the index reaction induced the BTR. In the other 482 BTRs (69.8%) the culprit ICM was changed to another non-culprit ICM.
UNASSIGNED: To the best of our knowledge, this is the largest study on patients with BTRs, and the first study showing BTRs in two centers in two countries of two continents. The main differences between the two centers result from the different hospital size, the number of patients, and the different documentation [manual (Bern) vs. electronical screening (Seoul)]. BTRs are no contraindications for further ICM-application. We recommend performing an allergy skin test as basis for the decision-making process of the next contrast-enhanced image-guided examination.
摘要：
■尽管有几项研究涉及造影剂（CM）超敏反应患者的突破反应（BTRs），这一现象仍不清楚。因此,本研究旨在深入分析两个国家的BTR患者.
■我们回顾性分析了来自两家三级护理学术医院（首尔/韩国，具有专门针对CM超敏反应的特殊监测系统，伯尔尼/瑞士，手动操作)关于基本流行病学数据，每位患者的BTR数量，以及后续分析中的严重程度等级。研究期间从2013年（2000年伯尔尼）持续到2017年。
■我们确定了445名BTR患者（91.5%来自首尔）和691名BTR（94.5%来自首尔）。大多数反应温和，11%中度和3.9%重度。在首尔,我们发现了多达10个BTR的患者，在伯尔尼,只有一个BTR患者。没有发生致命反应或死亡。在大多数情况下,BTR和指征反应的严重程度相同(80.8%).轻度指数反应保持恒定在90.6%。相比之下,在中度指标反应中，86.8%的严重程度下降/保持相同，13.2%的严重程度上升。在严重的指标反应中，55.6%的BTR反应再次严重，44.4%的患者严重程度下降。在158个BTR（22.9％）中，指数反应的罪魁祸首碘化造影剂（ICM）诱导了BTR。在其他482BTR（69.8％）中，罪魁祸首ICM更改为另一个非罪魁祸首ICM。
■据我们所知,这是对BTR患者的最大研究，第一项研究显示了两大洲两个国家的两个中心的BTR。两个中心之间的主要差异来自不同的医院规模，病人的数量,和不同的文档[手册（伯尔尼）与电子筛选(首尔)]。BTR不是进一步应用ICM的禁忌症。我们建议进行过敏皮肤测试，作为下一次对比度增强图像引导检查的决策过程的基础。
■我们回顾性分析了来自两家三级护理学术医院（首尔/韩国，具有专门针对CM超敏反应的特殊监测系统，伯尔尼/瑞士，手动操作)关于基本流行病学数据，每位患者的BTR数量，以及后续分析中的严重程度等级。研究期间从2013年（2000年伯尔尼）持续到2017年。
■我们确定了445名BTR患者（91.5%来自首尔）和691名BTR（94.5%来自首尔）。大多数反应温和，11%中度和3.9%重度。在首尔,我们发现了多达10个BTR的患者，在伯尔尼,只有一个BTR患者。没有发生致命反应或死亡。在大多数情况下,BTR和指征反应的严重程度相同(80.8%).轻度指数反应保持恒定在90.6%。相比之下,在中度指标反应中，86.8%的严重程度下降/保持相同，13.2%的严重程度上升。在严重的指标反应中，55.6%的BTR反应再次严重，44.4%的患者严重程度下降。在158个BTR（22.9％）中，指数反应的罪魁祸首碘化造影剂（ICM）诱导了BTR。在其他482BTR（69.8％）中，罪魁祸首ICM更改为另一个非罪魁祸首ICM。
■据我们所知,这是对BTR患者的最大研究，第一项研究显示了两大洲两个国家的两个中心的BTR。两个中心之间的主要差异来自不同的医院规模，病人的数量,和不同的文档[手册（伯尔尼）与电子筛选(首尔)]。BTR不是进一步应用ICM的禁忌症。我们建议进行过敏皮肤测试，作为下一次对比度增强图像引导检查的决策过程的基础。
