A Narrative Review of Interprofessional Management of Contrast-Induced Anaphylaxis in a CT Patient on Home Oxygen: From Resuscitation to Systems Safety
Abstract
Background: Contrast-induced anaphylaxis (CIA) during CT is a rare, life-threatening emergency requiring a response extending far beyond radiology, especially in patients using home oxygen.
Aim: This review delineates the comprehensive, interprofessional management pathway for CIA in a patient on home oxygen, analyzing roles from resuscitation to systems safety.
Methods: A systematic search of five databases (2010-2024) informed a narrative synthesis structured by professional domains.
Results: Immediate, protocol-driven intramuscular epinephrine and advanced airway management are critical. Post-stabilization, coordinated follow-up—including observation for biphasic reactions, epinephrine auto-injector prescription, and permanent EMR allergy flagging—is essential. The case uniquely intersects with oxygen therapy, introducing fire risks during resuscitation and mandating post-event home safety inspections and family education on oxygen safety. Long-term pulmonary recovery may require physiotherapy.
Conclusion: Effective management demands a pre-planned, interdisciplinary protocol. This framework underscores the necessity of seamless coordination between acute care, primary care, allied health, and administrative/safety personnel to ensure optimal outcomes and prevent recurrence.
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References
Ansotegui, I. J., Sánchez-Borges, M., & Cardona, V. (2016). Current trends in prevalence and mortality of anaphylaxis. Current Treatment Options in Allergy, 3(3), 205-211. https://doi.org/10.1007/s40521-016-0094-0
Bardhan, I., Chen, H., & Karahanna, E. (2020). Connecting systems, data, and people: A multidisciplinary research roadmap for chronic disease management. MIS Quarterly, 44(1).
Burns, K. E., Laird, M., Stevenson, J., Honarmand, K., Granton, D., Kho, M. E., ... & Arora, S. (2021). Adherence of clinical practice guidelines for pharmacologic treatments of hospitalized patients with COVID-19 to trustworthy standards: a systematic review. JAMA network open, 4(12), e2136263-e2136263. doi:10.1001/jamanetworkopen.2021.36263
Campbell, R. L., Bellolio, M. F., Knutson, B. D., Bellamkonda, V. R., Fedko, M. G., Nestler, D. M., & Hess, E. P. (2015). Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. The Journal of Allergy and Clinical Immunology: In Practice, 3(1), 76-80. https://doi.org/10.1016/j.jaip.2014.06.007
Cardona, V., Ansotegui, I. J., Ebisawa, M., El-Gamal, Y., Rivas, M. F., Fineman, S., ... & Worm, M. (2020). World allergy organization anaphylaxis guidance 2020. World allergy organization journal, 13(10), 100472. https://doi.org/10.1016/j.waojou.2020.100472
Chiu, T. M., & Chu, S. Y. (2022). Hypersensitivity reactions to iodinated contrast media. Biomedicines, 10(5), 1036. https://doi.org/10.3390/biomedicines10051036
Choo, K. J. L., Simons, F. E. R., & Sheikh, A. (2013). Glucocorticoids for the treatment of anaphylaxis. Evidence‐Based Child Health: A Cochrane Review Journal, 8(4), 1276-1294. https://doi.org/10.1002/ebch.1925
Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668. https://doi.org/10.1148/radiol.2019192094
Ding, A., Joshi, J., & Tiwana, E. (2023). Patient safety in radiology and medical imaging. In Patient Safety: A Case-based Innovative Playbook for Safer Care (pp. 261-277). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-35933-0_18
Fiocchi, A., Bognanni, A., Brożek, J., Ebisawa, M., Schünemann, H., Ansotegui, I. J., ... & Wong, G. W. (2022). World allergy organization (WAO) diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines update–I–plan and definitions. World allergy organization journal, 15(1), 100609. https://doi.org/10.1016/j.waojou.2021.100609
Grabenhenrich, L. B., Dölle, S., Ruëff, F., Renaudin, J. M., Scherer, K., Pföhler, C., ... & Worm, M. (2018). Epinephrine in severe allergic reactions: the European Anaphylaxis Register. The Journal of Allergy and Clinical Immunology: In Practice, 6(6), 1898-1906. https://doi.org/10.1016/j.jaip.2018.02.026
Goldzweig, C. L., Orshansky, G., Paige, N. M., Miake-Lye, I. M., Beroes, J. M., Ewing, B. A., & Shekelle, P. G. (2015). Electronic health record–based interventions for improving appropriate diagnostic imaging: a systematic review and meta-analysis. Annals of internal medicine, 162(8), 557-565. https://doi.org/10.7326/M14-2600
Greenhalgh, T., Thorne, S., & Malterud, K. (2018). Time to challenge the spurious hierarchy of systematic over narrative reviews?. European journal of clinical investigation, 48(6), e12931. https://doi.org/10.1111/eci.12931
Harrison, D. (2023). Radiology in Emergency Situations: Diagnosing and Managing Critical Cases. Indus Journal of Medical and Health Sciences, 1(02), 29-40. https://induspublishers.com/IJMHS/article/view/1285
Jabin, M. S. R., Schultz, T., Mandel, C., Bessen, T., Hibbert, P., Wiles, L., & Runciman, W. (2022). A mixed-methods systematic review of the effectiveness and experiences of quality improvement interventions in radiology. Journal of patient safety, 18(1), e97-e107. DOI: 10.1097/PTS.0000000000000709
Kashyap, M. V., & Blinman, T. A. (2021). Pain management in pediatric trauma. Current Trauma Reports, 7(3), 60-72. https://doi.org/10.1007/s40719-021-00216-y
Kellogg, K. M., Hettinger, Z., Shah, M., Wears, R. L., Sellers, C. R., Squires, M., & Fairbanks, R. J. (2017). Our current approach to root cause analysis: is it contributing to our failure to improve patient safety?. BMJ quality & safety, 26(5), 381-387. https://doi.org/10.1136/bmjqs-2016-005991
Lakoma, K., & Murphy, P. (2023). The evaluation of Safe and Well visits as part of the prevention activities of Fire and Rescue Services in England. International Journal of Emergency Services, 12(3), 271-282. https://doi.org/10.1108/IJES-09-2022-0053
Lee, S., Bellolio, M. F., Hess, E. P., & Campbell, R. L. (2014). Predictors of biphasic reactions in the emergency department for patients with anaphylaxis. The Journal of Allergy and Clinical Immunology: In Practice, 2(3), 281-287. https://doi.org/10.1016/j.jaip.2014.01.012
Li, X., Ma, Q., Yin, J., Zheng, Y. A., Chen, R., Chen, Y., ... & Zhai, S. (2022). A clinical practice guideline for the emergency management of anaphylaxis (2020). Frontiers in Pharmacology, 13, 845689. https://doi.org/10.3389/fphar.2022.845689
Lin, Y. Y., Chang, H. A., Kao, Y. H., Chuu, C. P., Chiang, W. F., Chang, Y. C., ... & Hsiao, P. J. (2023). Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission. Frontiers in Medicine, 10, 1163817. https://doi.org/10.3389/fmed.2023.1163817
Muraro, A., Roberts, G., Worm, M., Bilò, M. B., Brockow, K., Fernández Rivas, M., ... & EAACI Food Allergy and Anaphylaxis Guidelines Group. (2014). Anaphylaxis: guidelines from the E uropean A cademy of A llergy and C linical I mmunology. Allergy, 69(8), 1026-1045. https://doi.org/10.1111/all.12437
Nishizaki, F., Kitou, K., & Kuboike, S. (2018). What a Patient and His Family Should Do When Unable to Continue Home Oxygen Therapy and Home Mechanical Ventilation During a Blackout: When Unable to Continue Home Oxygen Therapy and Noninvasive Positive-Pressure Ventilation due to a Power Outage, What Should the Patient and Family Member (s) Do?. In Disaster and Respiratory Diseases (pp. 103-117). Singapore: Springer Singapore. https://doi.org/10.1007/978-981-13-2598-4_8
Robinson, M., Greenhawt, M., & Stukus, D. R. (2017). Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Annals of Allergy, Asthma & Immunology, 119(2), 164-169. https://doi.org/10.1016/j.anai.2017.06.001
Rochester, C. L., & Holland, A. E. (2020). Pulmonary rehabilitation and improved survival for patients with COPD. Jama, 323(18), 1783-1785. doi:10.1001/jama.2020.4436
Sánchez-Borges, M., Aberer, W., Brockow, K., Celik, G. E., Cernadas, J., Greenberger, P. A., ... & Trautmann, A. (2019). Controversies in drug allergy: radiographic contrast media. The Journal of Allergy and Clinical Immunology: In Practice, 7(1), 61-65. https://doi.org/10.1016/j.jaip.2018.06.030
Simons, F. E. R., Ardusso, L. R., Bilò, M. B., Cardona, V., Ebisawa, M., El-Gamal, Y. M., ... & Worm, M. (2014). International consensus on (ICON) anaphylaxis. World Allergy Organization Journal, 7, 9. https://doi.org/10.1186/1939-4551-7-9
Spielmanns, M., Gloeckl, R., Jarosch, I., Leitl, D., Schneeberger, T., Boeselt, T., ... & Koczulla, A. R. (2023). Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial. Thorax, 78(5), 442-450. https://doi.org/10.1136/thoraxjnl-2021-218338
Tanno, L. K., Chalmers, R., Bierrenbach, A. L., Simons, F. E. R., Martin, B., Molinari, N., ... & Academies, J. A. (2019). Changing the history of anaphylaxis mortality statistics through the World Health Organization's International Classification of Diseases–11. Journal of Allergy and Clinical Immunology, 144(3), 627-633. https://doi.org/10.1016/j.jaci.2019.05.013
Umakoshi, H., Nihashi, T., Takada, A., Hirasawa, N., Ishihara, S., Takehara, Y., ... & Terasawa, T. (2022). Iodinated contrast media substitution to prevent recurrent hypersensitivity reactions: a systematic review and meta-analysis. Radiology, 305(2), 341-349. https://doi.org/10.1148/radiol.220370
Voltolini, S., Cofini, V., Murzilli, F., Bignardi, D., Borro, M., Calamari, M., ... & Bilò, M. B. (2022). Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors. Eur Ann Allergy Clin Immunol, 54(2), 60-67. Doi: 10.23822/EurAnnACI.1764-1489.225
Woznitza, N., Piper, K., Rowe, S., & West, C. (2014). Optimizing patient care in radiology through team-working: a case study from the United Kingdom. Radiography, 20(3), 258-263. https://doi.org/10.1016/j.radi.2014.02.007
Wranik, W. D., Hayden, J. A., Price, S., Parker, R. M., Haydt, S. M., Edwards, J. M., ... & Levy, A. R. (2016). How best to structure interdisciplinary primary care teams: the study protocol for a systematic review with narrative framework synthesis. Systematic Reviews, 5(1), 170. https://doi.org/10.1186/s13643-016-0339-9
Authors
Copyright (c) 2024 Faisal Omar Aljohani, Sultan Abdullah Ibrahim Ageel, Fahad Abdulkreem Abdulrhman BinAyban, Adel Mohammed Jabril Qusayri4, Anwar Ahmed Shalani, Yasser Mansuor Musaib Alotaibi, Wedyan Meshal Alotaibi
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