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237 Urine histamine after intravenous contrast studies
237
URINE HISTAMINE AFTER INTRAVENOUS CONTRAST STUDIES. J. Dyer, S. Merlin, A. Greenhill, A. Shelton, G. Treadwell, P. Lieberman and M. Kaliner. Bethesda Md, Washington D.C. and Memphis, Tn. The IV injection of contrast media causes considerable morbidity. The mechanisms underlying the adverse reactions are unclear although histamine release may participate. In order to judge if histamine release accompanies contrast studies, urines were collected from 197 IVP studies during 1980 and 1982. Subjects voided prior to the study and postvoid film urines were collected 45 min later. Specimens were frozen and assayed by a modified fluorometric procedure. All subjects answered a questionaire detailing such reactions as pruritis, rhinorrhea, urticaria, asthma, and syncopy as well as treatments. Flushing and nausea were not considered adverse responses. Of the 197 subjects, 29 had reactions (15%), 19 had hives (10%) and 17 received Benedryl therapy (9%). Their urine histamines were: ng hist/ml nglmg creatlml 12.2tO.8 Controls 1;2 8.6+0.6 1o.z+1.9 21.3T3.8 Nonreactors 168 14.lT4.8 49.3T25.9 All Reactors 29 69.9x38.3 Hives 19 18.6E7.3
239
Conclusions: Subjects receiving contrast media have increased urine histamine compared to controls; patients experiencing reactions are increased further; and subjects developing hives are higher still. These data suggest that histamine release does accompany contrast injections.
238
ACETYL-SALICYLIC ACID THERAPY IN ASPIRINSENSITIVE ASTHMATICS. Gilbert BALDOCCHI, M.D., Daniel VERVLQET, M.D. and Jacques CHARPIN, Ma 'Marseille, France. Some studies tended to show that a treatment with acetyl-salicylic acid (ASA) could imorove the respiratory and nasal symptoms of ASA sensitive asthmatics, and could allow to decrease the corticosteroid dose Cl). After inducing progressive ASA tolerance, we clinically and functionnatty surveyed asthmatics under prolonged ASA therapy. Nine severe corticodependant asthmatics, with a positive oral challenge (fall of FEVl b 30% for ASA doses between 50 and 150 mg) were treated with rapidly increasing doses of ASA until 500 mg daily. Clinical score, therapy used and peak expiratory flow CPEF) measured with mini-wright peak flow meter were recorded daily by each patient. In 6 cases, ASA-
therapy
was
stopped
either
by
the
240
affllnar air flow particulate air (HEPA) filtration system as adjunct to the management of 37 atopic (dust and pollen sensitive) children with moderate asthma was studied during 8 weeks beginning 5/31182. Groups (A & B) were studied durin 2 week &tatural (N), filter (F) and placebo P P) sequences.
Ini'iial mean FEVl/FVC%(74 vs 69),FVC%(82 YS 76), FEF 5-75% pred.(57 vs 48),TLC% pred.( 103 vs l@T), RV/ ! tC(.22 vs .26) were similar. Variables analyzed incTuded daily AM and PM peak expiratory flow rates, symptom scores (wheeze, cough, dyspnea, sputum, nasal congestion), medication scores (type, dosage, frequency) and activity (outdoor time). Average daily outdoor temperature, relative homid7ty, barometric pressure and 48 hour pollen and mold counts were also recorded. Pulmonary function tests were done before and after each 2 week period (5 sets). The only beneficial effect noted was in AM (pc.05) and PM (pc.05) nasal congestion (AFl vs Bll) andAM (p< .05) nasal congestion (BF2 vs Stil). Periods 1 and 2 occurred during the peak of the grass pollen season. Night-time HEPA filtration when used under the conditions of this study was not helpful as an adjunct to the management of these children with moderate atopic asthma.
patients
or by ourself because of the clinical aggravation, after a brief stability period. Three patients are still treated 3 to 5 months later : we noticed a progressive significant CP < O,Ol) decrease of PEF in 2 cases, in spite of corticosteroid maintenance. In the Last case, the PEF significantly increased after 3 months of stability, but this patient needed more corticosteroid. In conclusion, ASA may be tolerated during several weeks, but is not a good substitutive therapy in ASA-intolerance. Cl)
Stevenson
et
at.
J.A.C.I.
66,
1,
FAILURE TO DESENSITIZE AN ASPIRIN SENSITIVE ASTHMATIC ON TWO ASPIRIN DFSENSITIZATION ATTEMPTS. Bruce G. Martin, D.O. and William G. Culver, M.D., San Antonio, Texas A 39 year old male is followed ior asthma, aspirin and related drug sensitivity, nasal polyps and ankylosing spondylitis. Because nf persistent abnormal pulmonary function studies, nasal and chest symptomatology, and the need for analgesia, aspirin desensitization was undertaken producing marked rhinorrhea and 18% decrease in FEVl after the 100 mg dose. Thereafter doses of 600 mg were tolerated without symptoms. Maintenance of 10 gr daily was established but discontinued four weeks later because of persistent, refractory rhinorrhea and bronchospasm. Marked improvement resulted. Desensitization was reinstituted 4 months later for recalcitrant nasal and chest symptoms. Again marked rhinorrhea and 18% decrease in FEVl resulted but subsequent doses of 600 mg were well tolerated. Maintenance was instituted with aspirin doses up to 45 gr (2.93 gm) daily but profuse rhinorrhea forced withdrawal of aspirin after 3 weeks. Marked improvement again resulted. This case represents a failure oi aspirin desensitization to control nasal and chest symptoms in a moderately severe aspirin sensitive asthmatic with nasal polyps, and, in fact, seemed to worsen baseline nasal symptoms.
1980.
148
URINE HISTAMINE AFTER INTRAVENOUS CONTRAST STUDIES. J. Dyer, S. Merlin, A. Greenhill, A. Shelton, G. Treadwell, P. Lieberman and M. Kaliner. Bethesda Md, Washington D.C. and Memphis, Tn. The IV injection of contrast media causes considerable morbidity. The mechanisms underlying the adverse reactions are unclear although histamine release may participate. In order to judge if histamine release accompanies contrast studies, urines were collected from 197 IVP studies during 1980 and 1982. Subjects voided prior to the study and postvoid film urines were collected 45 min later. Specimens were frozen and assayed by a modified fluorometric procedure. All subjects answered a questionaire detailing such reactions as pruritis, rhinorrhea, urticaria, asthma, and syncopy as well as treatments. Flushing and nausea were not considered adverse responses. Of the 197 subjects, 29 had reactions (15%), 19 had hives (10%) and 17 received Benedryl therapy (9%). Their urine histamines were: ng hist/ml nglmg creatlml 12.2tO.8 Controls 1;2 8.6+0.6 1o.z+1.9 21.3T3.8 Nonreactors 168 14.lT4.8 49.3T25.9 All Reactors 29 69.9x38.3 Hives 19 18.6E7.3
239
Conclusions: Subjects receiving contrast media have increased urine histamine compared to controls; patients experiencing reactions are increased further; and subjects developing hives are higher still. These data suggest that histamine release does accompany contrast injections.
238
ACETYL-SALICYLIC ACID THERAPY IN ASPIRINSENSITIVE ASTHMATICS. Gilbert BALDOCCHI, M.D., Daniel VERVLQET, M.D. and Jacques CHARPIN, Ma 'Marseille, France. Some studies tended to show that a treatment with acetyl-salicylic acid (ASA) could imorove the respiratory and nasal symptoms of ASA sensitive asthmatics, and could allow to decrease the corticosteroid dose Cl). After inducing progressive ASA tolerance, we clinically and functionnatty surveyed asthmatics under prolonged ASA therapy. Nine severe corticodependant asthmatics, with a positive oral challenge (fall of FEVl b 30% for ASA doses between 50 and 150 mg) were treated with rapidly increasing doses of ASA until 500 mg daily. Clinical score, therapy used and peak expiratory flow CPEF) measured with mini-wright peak flow meter were recorded daily by each patient. In 6 cases, ASA-
therapy
was
stopped
either
by
the
240
affllnar air flow particulate air (HEPA) filtration system as adjunct to the management of 37 atopic (dust and pollen sensitive) children with moderate asthma was studied during 8 weeks beginning 5/31182. Groups (A & B) were studied durin 2 week &tatural (N), filter (F) and placebo P P) sequences.
Ini'iial mean FEVl/FVC%(74 vs 69),FVC%(82 YS 76), FEF 5-75% pred.(57 vs 48),TLC% pred.( 103 vs l@T), RV/ ! tC(.22 vs .26) were similar. Variables analyzed incTuded daily AM and PM peak expiratory flow rates, symptom scores (wheeze, cough, dyspnea, sputum, nasal congestion), medication scores (type, dosage, frequency) and activity (outdoor time). Average daily outdoor temperature, relative homid7ty, barometric pressure and 48 hour pollen and mold counts were also recorded. Pulmonary function tests were done before and after each 2 week period (5 sets). The only beneficial effect noted was in AM (pc.05) and PM (pc.05) nasal congestion (AFl vs Bll) andAM (p< .05) nasal congestion (BF2 vs Stil). Periods 1 and 2 occurred during the peak of the grass pollen season. Night-time HEPA filtration when used under the conditions of this study was not helpful as an adjunct to the management of these children with moderate atopic asthma.
patients
or by ourself because of the clinical aggravation, after a brief stability period. Three patients are still treated 3 to 5 months later : we noticed a progressive significant CP < O,Ol) decrease of PEF in 2 cases, in spite of corticosteroid maintenance. In the Last case, the PEF significantly increased after 3 months of stability, but this patient needed more corticosteroid. In conclusion, ASA may be tolerated during several weeks, but is not a good substitutive therapy in ASA-intolerance. Cl)
Stevenson
et
at.
J.A.C.I.
66,
1,
FAILURE TO DESENSITIZE AN ASPIRIN SENSITIVE ASTHMATIC ON TWO ASPIRIN DFSENSITIZATION ATTEMPTS. Bruce G. Martin, D.O. and William G. Culver, M.D., San Antonio, Texas A 39 year old male is followed ior asthma, aspirin and related drug sensitivity, nasal polyps and ankylosing spondylitis. Because nf persistent abnormal pulmonary function studies, nasal and chest symptomatology, and the need for analgesia, aspirin desensitization was undertaken producing marked rhinorrhea and 18% decrease in FEVl after the 100 mg dose. Thereafter doses of 600 mg were tolerated without symptoms. Maintenance of 10 gr daily was established but discontinued four weeks later because of persistent, refractory rhinorrhea and bronchospasm. Marked improvement resulted. Desensitization was reinstituted 4 months later for recalcitrant nasal and chest symptoms. Again marked rhinorrhea and 18% decrease in FEVl resulted but subsequent doses of 600 mg were well tolerated. Maintenance was instituted with aspirin doses up to 45 gr (2.93 gm) daily but profuse rhinorrhea forced withdrawal of aspirin after 3 weeks. Marked improvement again resulted. This case represents a failure oi aspirin desensitization to control nasal and chest symptoms in a moderately severe aspirin sensitive asthmatic with nasal polyps, and, in fact, seemed to worsen baseline nasal symptoms.
1980.
148