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57. In vitro histamine and serotonin release by radiographic contrast media (RCM) in man
VOLUME 61 NUMEER 3
Abstra~s
adiocontrast media-induced histamine nd complement consumption in ~WIS. Frederick C. Cogen, M.D., J. Hirshfeld, D.: E. Dunsky, M.D., M. Norman, M.D., and Zweiman, M.D., Philadelphia, Pa. The mechanism of anaphylactoid reactions following intravenous injection of radiocontrast media (RCM) remains undefined, We have studied serial changes in plasma histamine (H) and complement (C) in 6 consecutive patients without prior RCM reactions undergoing cardiac catheterization. Aortic root blood was sampled before and after a 50-cc injection of RCM into the pulmonary artery. H was undetectable in all pre-RCM samples (CO.5 rig/ml) but was elevated as early as 1 min in 5 of 6 patients (7 to 32 ngjml) and remained elevated at 3 (2 to 80 rig/ml) and 5 (4 io 29 rig/ml) min. No patient developed clinical or hemodynamic abnormalities. C data in 4 of the patients were as shown in Table I, Partial conversion of factor B was detected by immunoelectrophoresis in 2 patients.
CH5,,
Atlmin Post-RCM
18
% decrease
Ct
C$
Cg
10
19
15
Factor
B*
15
Properdin*
25
*@anmated by radial immunodiffusion Findings of frequent prominant RCM-induced in vivo H in these patients supports the concept that allergy-type mediator release is not reagin mediated. In vivo C consumption involved both classical and alternative pathway components. It is unclear whether RCM-induced H release is a direct effect on basophils (mast cells) or occurs indirectly via C activation.
. Radiographic contrast media (KM) infusions: Measurement of mediators and correlation with clinical parameters. R. A. .D., M. Schatz, M.D., D. D. Stevenson, Simon, M.D., N. Curry, M.D., F. Yamamoto, M.D., E. Plow, Ph.D., H. Ring, M.D., and C. M. Arroyave, M.D., La Jolla, Calif. To further understand the effects of RCM infusion, 43 patients underwent clinical evaluation and skin testing at least 48 hr before receiving a bolus of Renografin-60 (meglumine diatrizoate [52%] and sodium diatrizoate [8%]) for intravenous pyelography Serial venous plasma samples were abtained before and after the infusions. Immediate generalized reactions occurred in 6 of the patients. Each of the 43 patients had a change in at least one of the mediators measured. In 43%, plasma histamine (H), measured by radioisotopic enzymatic assay, rose (mean, 3.1 Z! 1.62 rig/ml). In 63%, serum complement (C), mea-
145
sured as hemoIytic activity, decreased (mean, 3@ * 19%). In 41%, fibrin split products (FSP) were detected by radioimmunoassay. We compared the 6 patients experiencing reactions to the remaining 37 nonreactors and found no correlations between: rise in H, decrease in C, presence of FSP, personal history of allergy, prior exposure or reaction to RCM, skin tests to RCM, histamine, or saline. Although changes in H, C, and FSP occurred in a substantial number of patients undergoing RCM infusions these changes could not be correlated with immediate generalized reactions or the previously described clinical parameters. It is probable that other modulating factors play significant roles in determining whether or not a reaction occurs.
57. In vitro histamine and serot by radiographic contrast media man. Johannes Ring, M.D., Garbs M. M.D., Marvin J. Fritzler, M.D., La Jolla, Calif.
Mean
of papers
M.D., and Eng
Peripheral leukocytes and platelets from 20 beahhy volunteers were incubated in vitro with radiographic contrast media (diatrizoate-Hypaque, iothalamate-Conray, and iodipamide-Cholografin) under varying conditions. All RCM were able to induce histamine release from peripheral leukocytes and the release reaction was dose dependent. The addition of normal human serum (NILS) to the reaction mixture led to a further increase in histamine release (p < 0.01) probably due to complement activation. The mechanism seems to be mediated by proteins of the alternative pathway because serum depleted of complement components (factor B, factor D, properdin) did not show this synergistic effect. IgG-depleted serum, however? was abie to show the augmented release reaction. Washed platelets incubated with RUM-released serotonin in a dose- and time-dependent reaction. The most powerful serotonin-releasing RCM was found to be iodipamide. The serotonin release was not due to platelet lysis, as determined by the concentration of lactic dehydrogenase present in the supematant during serotonin release. Incubation of buffy coat with RCM produced ultrastructural changes including degranulation of basophils, aggregation of platelets, and infiltration of the aggregates by polymorphonuclear leukocytes. The most prominent changes were observed when complement was present in the reaction mixture.
58. Studies of complement (Cl in reactions to iodinated Contras (ICM). Phil Lieberman, M.D.g and M.D., Memphis,
le,
Tenn.
In order to better understand me pathogenesis of acute reactions to ICM, 16 patients experiencing such reactions
Abstra~s
adiocontrast media-induced histamine nd complement consumption in ~WIS. Frederick C. Cogen, M.D., J. Hirshfeld, D.: E. Dunsky, M.D., M. Norman, M.D., and Zweiman, M.D., Philadelphia, Pa. The mechanism of anaphylactoid reactions following intravenous injection of radiocontrast media (RCM) remains undefined, We have studied serial changes in plasma histamine (H) and complement (C) in 6 consecutive patients without prior RCM reactions undergoing cardiac catheterization. Aortic root blood was sampled before and after a 50-cc injection of RCM into the pulmonary artery. H was undetectable in all pre-RCM samples (CO.5 rig/ml) but was elevated as early as 1 min in 5 of 6 patients (7 to 32 ngjml) and remained elevated at 3 (2 to 80 rig/ml) and 5 (4 io 29 rig/ml) min. No patient developed clinical or hemodynamic abnormalities. C data in 4 of the patients were as shown in Table I, Partial conversion of factor B was detected by immunoelectrophoresis in 2 patients.
CH5,,
Atlmin Post-RCM
18
% decrease
Ct
C$
Cg
10
19
15
Factor
B*
15
Properdin*
25
*@anmated by radial immunodiffusion Findings of frequent prominant RCM-induced in vivo H in these patients supports the concept that allergy-type mediator release is not reagin mediated. In vivo C consumption involved both classical and alternative pathway components. It is unclear whether RCM-induced H release is a direct effect on basophils (mast cells) or occurs indirectly via C activation.
. Radiographic contrast media (KM) infusions: Measurement of mediators and correlation with clinical parameters. R. A. .D., M. Schatz, M.D., D. D. Stevenson, Simon, M.D., N. Curry, M.D., F. Yamamoto, M.D., E. Plow, Ph.D., H. Ring, M.D., and C. M. Arroyave, M.D., La Jolla, Calif. To further understand the effects of RCM infusion, 43 patients underwent clinical evaluation and skin testing at least 48 hr before receiving a bolus of Renografin-60 (meglumine diatrizoate [52%] and sodium diatrizoate [8%]) for intravenous pyelography Serial venous plasma samples were abtained before and after the infusions. Immediate generalized reactions occurred in 6 of the patients. Each of the 43 patients had a change in at least one of the mediators measured. In 43%, plasma histamine (H), measured by radioisotopic enzymatic assay, rose (mean, 3.1 Z! 1.62 rig/ml). In 63%, serum complement (C), mea-
145
sured as hemoIytic activity, decreased (mean, 3@ * 19%). In 41%, fibrin split products (FSP) were detected by radioimmunoassay. We compared the 6 patients experiencing reactions to the remaining 37 nonreactors and found no correlations between: rise in H, decrease in C, presence of FSP, personal history of allergy, prior exposure or reaction to RCM, skin tests to RCM, histamine, or saline. Although changes in H, C, and FSP occurred in a substantial number of patients undergoing RCM infusions these changes could not be correlated with immediate generalized reactions or the previously described clinical parameters. It is probable that other modulating factors play significant roles in determining whether or not a reaction occurs.
57. In vitro histamine and serot by radiographic contrast media man. Johannes Ring, M.D., Garbs M. M.D., Marvin J. Fritzler, M.D., La Jolla, Calif.
Mean
of papers
M.D., and Eng
Peripheral leukocytes and platelets from 20 beahhy volunteers were incubated in vitro with radiographic contrast media (diatrizoate-Hypaque, iothalamate-Conray, and iodipamide-Cholografin) under varying conditions. All RCM were able to induce histamine release from peripheral leukocytes and the release reaction was dose dependent. The addition of normal human serum (NILS) to the reaction mixture led to a further increase in histamine release (p < 0.01) probably due to complement activation. The mechanism seems to be mediated by proteins of the alternative pathway because serum depleted of complement components (factor B, factor D, properdin) did not show this synergistic effect. IgG-depleted serum, however? was abie to show the augmented release reaction. Washed platelets incubated with RUM-released serotonin in a dose- and time-dependent reaction. The most powerful serotonin-releasing RCM was found to be iodipamide. The serotonin release was not due to platelet lysis, as determined by the concentration of lactic dehydrogenase present in the supematant during serotonin release. Incubation of buffy coat with RCM produced ultrastructural changes including degranulation of basophils, aggregation of platelets, and infiltration of the aggregates by polymorphonuclear leukocytes. The most prominent changes were observed when complement was present in the reaction mixture.
58. Studies of complement (Cl in reactions to iodinated Contras (ICM). Phil Lieberman, M.D.g and M.D., Memphis,
le,
Tenn.
In order to better understand me pathogenesis of acute reactions to ICM, 16 patients experiencing such reactions