There was no statistically or clinically significant increase in risk of anaphylactic reaction (AR) from cardiac catheterization (CC) using intra-arterial low osmolar contrast media in patients receiving beta blockers or angiotensin-converting enzyme (ACE) inhibitors, according to a recent article published in The Journal of Allergy and Clinical Immunology: In Practice.

Researchers reviewed charts of 71,782 patients who underwent left heart catheterization at the Cleveland Clinic Foundation Main Campus between January 2004 and December 2013. There were 46 cases of AR (0.064%) identified and 86 matched controls who underwent the same procedural technique and in the same catheterization labs. The identified AR cases were separated into mild-moderate (n=35), severe (n=5), and life-threatening (n=6).

Medication exposures were similar in the control and reactor groups. Beta blockers were used the most frequently among patients, with 64% in the control group and 56.5% in the reactor group (P =.40). ACE inhibitors usage was the same for both groups. Angiotensin receptor blocker (ARB) usage was higher in the reactor group compared with the control group (18% vs 8%, P =.11).

There was no apparent difference in medication exposure when comparing patients with severe/life-threatening AR with those who had mild-moderate AR for beta blockers (45% vs 60%), ACE inhibitors (18% vs 43%), or ARB (18% vs 17%). Types of medication also had no impact on AR frequency. Neither cardioselective beta blockers nor noncardioselective beta blockers influenced the rate of AR (P =.2 and P =.5, respectively).

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This study had several limitations. It was a retrospective review, so uncontrollable variables could have caused bias. In the initial chart review, 24 reactor cases were excluded due to not being compatible with AR, but this may have been due to poor documentation of symptoms. In charts reviewed, there was a bias in the type of beta blocker prescribed (specifically, cardioselective metoprolol), which limited the conclusions for noncardioselective beta blocker exposure. The sample size was not large enough to be definitive. For a definitive study, data for all CC in the United States for 2 to 3 years would be needed, which may not be feasible. 

“Our findings do not support the contention that patients undergoing CC are candidates for risk reduction measures for [beta blocker] or ACE [inhibitors] exposure prior to receiving [low osmolar contrast media],” concluded the researchers.

Reference

Smith MA, Newton LP, Barcena Blanch MA, et al. Risk for anaphylactic reaction from cardiac catheterization in patients receiving β-Adrenergic blockers or angiotensin-converting enzyme-inhibitors [published online November 1, 2019]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2019.10.020