Risk of contrast medium reactions in cardiac diagnosis. Pretreatment with glucocorticoids and antihistaminics in known cases of intolerance to contrast media

: Among 4178 patients who between 1980 and 1986 had undergone left-heart catheterization with left-heart injections and coronary angiography there were 76 (1.8%) with previous reactions to contrast media. These latter patients were given, three days before the planned investigation, 6 alpha-methylprednisolone, 24 mg daily by mouth, and phenhydramine hydrogenmaleinate, 150 mg daily, and two hours before the investigation 80 mg 6 alpha-methylprednisolone hemisuccinate intravenously. The effect of this prophylactic regimen was tested prospectively. Diatrizoate 76% was the contrast medium used. Of 4102 patients without known contrast-medium intolerance 137 (3.34%) had a reaction, 27 of them (0.66%) severe enough to require treatment. Among the 76 patients with known previous reactions, nine (11.8%) had reactions, one very severe requiring treatment, the others mild. The described pre-injection regimen thus allows indicated left-heart contrast-medium injection to be undertaken at a justifiable risk.