Peri-anaesthetic anaphylaxis due to radiographic contrast medium : the role of intradermal testing in diagnosis and management : case study

Severe allergic reactions during a general anaesthetic can be caused by a wide variety of agents, ranging from muscle relaxants to anaesthetic agents, cleaning agents, pain killers, latex and antibiotics. The process of deciphering which agents are responsible can be time consuming and difficult. Radiographic contrast media (RCM) are increasingly used in modern diagnostic medicine and may be used whilst the patient is under general anaesthetic, adding an additional agent which can cause a reaction. This case report illustrates a severe reaction to a non-ionic low molecular weight radiographic contrast medium, iopramide (Ultravist) and illustrates the value of diagnostic testing to identify the offending agent, as well as to identify potential alternative agents. It is one of only a few cases in the literature to demonstrate a clearly positive reaction by intradermal test.