Was this experience definitely anaphylaxis? Years ago when often getting X-rays for kidney stones, I used to receive what I understood was a big IV dose of iodine radiopaque dye for contrast. Increasingly as the years went by, I’d get a bad reaction whenever I’d have this procedure. My airways would close up, I’d get extremely wheezy, my nose would run profusely, my eyes would water, I would feel flushed and hot and itchy, and most significantly I’d have difficulty breathing, anxiously feeling like I was both choking and drowning. I’d already have an IV running, and I think they’d treat this with stearoids and antihistamine. I don’t recall if they used epinephrine. In later years they’d prepare me in advance with 200 mg of Prednisone.
I want to know so that when I fill out medical forms that ask about drug reactions, can I simply write “anaphylaxis”? Or would that not necessarily be correct and I need to describe all the symptoms as I did above? Web references describing anaphylaxis seem accurate but don’t make clear whether any experience fitting that description is necessarily anaphylaxis by definition.
It’s in a section about allergic reactions to drugs, and there are two small spaces, one for the drug and one for what the reaction was. So it’s already implicit I had an allergic reaction to iodine radiopaque dye.
Disclaimer: I am not your doctor. I am not an allergist.
Allergic reactions can be mild (itchy, hives everywhere, watery eyes) or life-threatening (swollen face or neck, lose consciousness, very low blood pressure, airways compromise). Symptoms like wheezing can mean a serious reaction depending on the degree and cause. Even vomiting can be serious.
They used to distinguish between types of anaphylaxis by the chemical cause (IgE, mast cells, drugs such as aspirin). But in the emergency department, you can’t easily tell the immunochemical and it doesn’t change treatment. Anaphylaxis is generally thought to mean a life threatening allergic reaction.
It’s a grey area because strong medicines (like epinephrine) should be given early at the first serious signs to prevent further problems. But the fact you were given strong medicine by itself does not mean it was life-threatening — clinicians might disagree about symptoms like vomiting and wheezing might be a whistling noise or a closed airway.
So I would call it an allergic reaction. On a medical form, I would also use the word “serious” and list all the symptoms. It could well have been anaphylaxis, but not definitely so. This might have other insurance implications. If they gave you epinephrine or Ventolin, you would want those handy. But if it was anaphylaxis they probably wouldn’t give you the contrast ever again.
Thank you Dr_Paprika! This sounds very reasonable and actionable. I’m going with it. If they plan to use any contrast we will discuss it. Turns out, elsewhere on the long form, they ask me to circle IODINE if I’m allergic to it, so it’s a familiar question.
Hey, wish me good luck! This is to get a colonoscopy. I’m almost 62 and it’s been 6.5 years since the last one. Normally I wouldn’t be worried, but last time they put a 100 mm tear in my colon, and gave me peritonitis which took 28 hours to diagnose. I had emergency surgery and a 7 day hospital stay, and now I resemble a football with a long seam up the middle.
Once I started walking up and down the hospital halls with my IV pole, I discovered a cardiology ward around the corner, with a long gleaming white hallway. The end of the hallway was a solid glass wall that glowed with skylight, so I’d be walking toward the light. Who designs a cardiology ward that way???
This reaction is extremely common to some iodinated contrast media. Unless you have been told that you had anaphylaxis, just list the symptoms and your medical team will take it from there.
Many times, I filled orders for prednisone AND Benadryl AND Pepcid, just to cover all the bases. (Yes, Pepcid has an antihistaminic effect; H2 is a histamine that modulates, among other things, the production of stomach acid.)
For the sake of completeness, a serious allergic reaction with any signs of facial swelling, severe wheezing, low blood pressure, decreased consciousness, vomiting (with other allergic stigmata) should be treated with epinephrine (same thing as adrenaline). This is the only first line drug, which is why expensive EpiPens are a thing. Everything else is just kind of helpful. Most deaths from anaphylaxis are directly due to delay in receiving epinephrine.
Antihistamines (Benadryl is the most effective) are useful for mild symptoms, but usually are added to the treatment of anaphylaxis anyway. It is true H2 antihistamines such as Pepcid or ranitidine are often added too due to a different mechanism, but the difference is probably not huge). Steroids such as prednisone are used in moderate reactions; salbutamol might be used for wheezing; some fluid resuscitation may be needed if there is shock. The best treatment for allergies is to avoid triggers.