DrFrankLichtenberg wrote on 05/31/12 at 04:52:49:I don't know, but I think you mean an IgE(Immediate reaction) to contrast. IV contrast degranulates basophils based on the osmotic nature of the material. I'm not sure if it has been documented of a true IgE reaction because there wouldn't be a way to tell the difference. There is always the first person do define the condition......
Well, it wouldn't be the first time I end up doing a "first"
, it seems to be something I'm good at doing, Doctor. I'm the first known masto patient to have my aortic aneurysm repaired and the 2nd to face open heart surgery. I recently reacted to DMSA contrast for scintigraphy, a nuclear medicine exam, and I've a known autoimmune case which is affecting my kidneys and apparently has a major role in my becoming allergic to CT contrast. One of the authorities is who raised the suspicion for an IgG mediated allergy for I am totally IgE negative for allergies.
In 2004 I had contrast prior to my masto becoming active. I had no reaction to the contrast. In 2007, I had contrast again with an angiogram shortly after surgery when my doctors were suspecting a pulmonary embolism. The crisis that made them suspect the embolism was in truth anaphylaxis, but they couldn't recognize it since my pressure was 160/110. I didn't react to the contrast and the recent surgery was the last straw event which activated the hidden mast cell disorder. Another CT 6 months later, looking for a carcinoid tumor, was a barrium swallow and I had strong reacting to the contrast with intense flushing and explosive diarrhea which lasted a full week. Another 6 months later, after my angiologist saw the aortic aneurysm, she asked for another angiogram with contrast and in spite of having pre-medicated with the common anti-allergy meds I had a severe reaction with pressure of 220/110 and an immediate LOC - I was brought to and left to recover but about 20 minutes after having the contrast I went into a 3 hour long syncope which nobody was able to wake me from.
Another 6 months later, another angiogram due to the size of my aneurysm. This time we used the REMA protocols and they kept my pressure normal - it was beautiful! - but again 20 minutes after the contrast, I went into prolonged syncope, this time lasting 4 hours!
We continued using these protocols with a cystoscope, endo & colonoscope, BMB and gallbladder surgery and with each and every single exam, I had no reacting on the table. The prolonged syncope, however, did indeed follow and for each of those exams the syncope lasted 2 hours except for the surgery which lasted for 5 long torturous hours! What we learned is that the syncope is a reflection as to how severe the degranulation is. According to research, this is caused by intense vasoplegia. My doctors have confirmed that I do indeed go into vasoplegia. The protocols WORK and work beautifully, but why they don't seem to keep me from going into this syncope, we don't know yet. Yet, from what we could see, the strength of the reacting is reflected through the syncope.
So, when I had to face yet another angiogram a year following the other two, we again used the REMA protocols without any concern to my safety. It had not ocurred to us that I was growing increasingly more "reactive" to the contrast. We did everything as we had done before and yet this time I reacted to the contrast immediately upon injection! I had intense flushing, intense dyspnea and abdominal pain with pressure of 180/110. The REMA protocols didn't hold me and again, 20 minutes after the contrast I went into 6 full hours of syncope!
The following day my angiologist confirmed that this was without a doubt autoimmune in nature (I have an ANA of 1:320, hashimoto's an a positive ASST test). and that I have become increasingly reactive to the contrast. She also confirmed the vasoplegia.
When I had to do a DMSA exam last August, I had researched this contrast and found that it was considered completely safe. The radiologist doctor told me that there was NO NEED for concern because NO ONE has EVER reacted to this contrast. I didn't even pre-medicate for I felt that this was a SAFE exam for me, no different than a CT without contrast. The doctor was SHOCKED
when he was called to attend me and saw for himself, the hematoma on my wrist where the contrast had been injected, the intense flushing, dyspnea, tachicardia and near syncope! He about called the ambulance, but I kept him from doing so because I was combating it with my meds and had even hit in with prednisone.
The suspicion that this is IgG mediated was raised by a masto authority, not my doctors. We can't seem to figure that it could be anything else for IgE mediated it is not.
It would be my luck to break the rules once again, Dr. Lichtenberg!
It gets really OLD, really QUICK! Such is life with a rare disease, you do some really weird things at times!
Lisa