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Anaphylaxis during a heart catheterization, is the beta blocker to blame?

Published online: November 1, 2019

In the 1980’s and 1990’s, several studies found that there was a link between patients who were prescribed a beta blocker (BB) medication and had a more serious anaphylactoid reaction during an intravenous contrast enhanced study, such as a CAT scan. Many patients who undergo an intra-arterial contrast enhanced heart catheterization are chronically taking BB medications. Low osmolar contrast, which has been associated with a substantial reduction in rates of anaphylactoid and serious anaphylactoid reaction, has become the standard in the modern era based on its safety advantage; increased risk of concomitant BB use has not been established in association with low osmolar contrast material.

In a recently published study by Smith et al in The Journal of Allergy and Clinical Immunology: In Practice, more than 70,000 cardiac catheterization records were analyzed, in an effort to determine whether medication exposure to BB was associated with more frequent or severe anaphylaxis episodes. Apart from BB use, another medication of interest to the researchers was angiotensin converting enzyme inhibitors (ACE-I), such as lisinopril, which have also been implicated in more severe anaphylaxis episodes in certain patients. Patients who had anaphylactoid reactions were compared to controls (who had an uneventful contrast procedure on a similar date) in regard to medications, demographics, and comorbid medical conditions.

In patients who underwent a cardiac catheterization with low osmolar contrast, the use of BB or ACE-I was not found to be a statistically significant risk factor for developing anaphylaxis.

In this case-control study, severe anaphylactoid reactions to low osmolar contrast administered intra-arterially prior to cardiac catheterization were rarely observed. Exposure to BB or ACE-I were not associated with a statistically significant increase in rates or severity of anaphylactoid reaction; however, most BB were cardioselective. These findings imply BB or ACE-I suspension is not warranted prior to cardiac catheterization.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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