Thursday, 15 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)
Background Nonimmediate reactions induced by radio contrast media (RCM) are an important health problem because nearly 50 % of patients with a suspected nonimmediate reactions to RCM are confirmed as allergic (Gomez E, et al. Curr Opin Clin Immunol 2013;13:345-53). Case Record A 60-year-old female was brought to emergency department with chief complaint of hemoptysis one day after transient dry cough. Past medical history included current smoking in 30 pack-per-years, acute hypersensitivity reaction with nicotinic α4β2 receptor partial agonist valenicline, epilepsy on phenytoin and phenobarbiturate, and pollinosis. Body temperature 98.5 F, blood oxygen saturation 95 % in room air; No crackle, stridor, nor wheeze was audible. Contrast chest computed tomography show atelectasis in left lower lobe, but not about carvenous lesion, pulmonary arteriovenous fistula, nor racemose hemangioma. Bronchoscopy detected thrombus in left lower lobe; Mycobacterium avium, intracellulare, and tuberculosis were negative in bronchoalveolar lavage fluid. Specific immunofluorescence in M. tuberculosis was also in negative. Serum test was thoroughly negative in SCC, CYFRA, ProGRP, NSE, IgG4, PR3- and MPO-ANCA, Aspergillus, (1,3→) βD-glucan, ANA, ds-DNA-IgG, anti-RNP, anti-sm, and anti-GBM antibodies. Clinical diagnosis of chronic bronchitis was made with findings described above. Pruritus exanthema in trunk one-and-a-half day after contrast media iomeprol infusion (Dona I, et al. J Investig Allergy Clin Imunol 2014;24:143-53) was disappeared several days after bepotastine besilate administration. Discussions Global Initiative of Asthma (GINA) step 1 was hypothesized because patients who were treated with GINA step 1 have reported to have over 3-fold-increased risk to develop acute hypersensitivity reaction as compared with patients who did not have asthma (Kobayashi D, et al. Chest 2012;141:1367-8). Conclusions Pharmacogenetics and/or transcriptomics should be helpful to clarify T-cell mediated mechanisms in development of RCM hypersensitivity reaction (Fernandez TD, et al. Allergy 2014;69:150-8).