Allergic Reaction to Contrast Dye

[Chicken]

this is not gongfu related - well other than Hengxuan's wonderment at the high standard and no-cost aspects of National Health Hospitals in the UK. e.g. "Can chinese people come here and not have to pay?" "But it doesn't smell like medicine as Chinese hospital's do?" Also noted now is his approach to all illness: "Must cook chicken soup!"

I had a procedure to get to the bottom of my PCOS, which involved contrast dye at 6pm. It was a breeze, minimally uncomfortable for the 3 minutes the procedure took, and the outcome was what we wanted. We then ran a few errands, got in, had a bite to eat and a cup tea then 2 hours after the procedure...

• severe lower adomen pain
• vomiting
• urticaria (rash over face and neck)

I got a hot water bottle, and took some Ibruprofen. I checked on the internet and it suggested that if you develop a rash and breathing difficulties you should get yourself medical assistance. So on the phone to the medical team that performed the procedure, I got a niggle in my right lower back ribcage... and we concluded that I should go to Casualty as a precaution. We got there about 9pm.

As I suspected we got bumped up the triage queue, so i didn't get to sit in the casualty clowning around with my brother and Hengxuan, and was so spared discussing exactly how he was going to prepare the chicken soup for too long. I got assessed by the nurse who noted that my blood pressure was low, then the house officer, by which time my blood pressure had picked up again, so they gave me two big Co-codemal and a Piriton, and told me to sit in the seating area for 30 mins until my condition stabilised.

15 mins in, the pain started getting worse... considerably worse, my cognition was hazy in places, then, I started developing pains completely accross my chest and shoulders... I got my brother to get the doctor's attention. The pains turned into pain accross the upper arms, constriction then pressure on the chest, very brief strangling senstation, and pins and needless in the hands. Breathing was laboured throughout.

They brought me back accross to one of the treatment rooms, where the nurse and doctor both mentioned that I had become transparent... I brought up the water that I had just taken the medication in, and stabilised a bit. They moved me to a bed, where (on top of the abdomen pain) I experienced pain round the front right of my ribcage and pain in a line down my right shoulder blade and back chest cavity. The A&E consultant took over.

They did an ECG which showed a borderline left ventrical failure (? or something along those lines?). So they took blood for some blood work (Hengxuan was horrified to see how much blood they were taking and couldn't watch the needles going in - big wuss!), put in an IV drip and some steroids, and took more blood from my wrist to check oxygen sats (again Hengxuan hiding in the corner). Ultimately they decided they wouldn't be sending me home that night.

Fortunately, other than the stomach pain and only being covered by a sheet, I had an uneventful time through the early hours and the rest of the morning. So they let me go home, with so many antibiotics that I'm going to be rattling over the next 7 days... and the abdomen pain has almost totally subsided over the second night.

I'm in very good health at the moment, yet this was very scary stuff... during the course of the evening, I registered fleeting moments of raw fear in both Hengxuan and my brother's eyes that they had been confronted with the prospect of losing me.

My entire family now understands Hengxuan's "Chicken Soup" approach to all illness. And its now brought it back to me why Guoyin called me "Chicken" in the first place... because when I am not well, its all Hengxuan talks about! Hengxuan's second policy towards illness is grounding - if I so much as talk about going anywhere he throws all his toys out his pram... in all of this, he's also disclosed, that other than to have his cavities filled and veruca's treated, he hasn't been to the doctors since he started training gongfu back in 1990...

Much happy fun!

Chicken

[Chicken]

BTL haha... I'm too young for premenopausal fears...

The only thing that will derail Hengxuan's parents' plans for an elaborate village wedding this summer in deepest Henan (which will involve every type of being center of attention torture, the prospect of having warring sets of parents together in China for the first time torture, not to mention traditional chinese bride torture) is the possibility that it could jeopardize a sunzi in the pipeline.

Evidently if you know you have PCOS, you have to be proactive about these things.

Chicken

[doc]

Was there a question associated with this? Just wanted to make sure, don't want to be delinquent in my "responsibilities" to the gang....

[Chicken]

Not really, unless you can explain what that left ventrical failiure was all about on the ECG, as the doctors all nicely skipped over that bit.

I've since understood that this is a pretty standard allergic reaction, albeit a severe one. In hindsight, I'm only glad that I made the decision to get to the hospital at the first twinge of chest pain. It would have be very frightening having such an episode anywhere other than in a hospital surrounded by medical professionals.

I've still got chest twinges, and I think my right kidney is now taking the brunt of it, as I'm still pretty saw down my entire right side and especially round the waist.

I will be staying away from Iodine in the future!

Chicken
(Looks like I'm gonna be eating chicken soup for some time now! )

[doc]

Left ventricular failure? I kind of wonder about that. There are no really specific ECG findings associated with LVF, you can have normal ECG's, as well as having various types of arrthymias, heart blocks, and axis deviations; it depends upon the cause of the failure, and the severity. If you really had LVF, you would not have been discharged the next morning, without a more extensive cardiac workup.

Also, your allergic reaction, though frightening (I can assure you of that), was not as serious as it could have been. Next time might be one hell of a lot worse. Careful with iodinated agents, seafood, iodinated salt, etc. (I'm assuming that it was an iodine based dye). You may not have any allergy issues to the above mentioned things, but, I would still at least keep it in mind. Eating it and getting injected with it tend to be two different things, but that doesn't mean that as you get older, you don't develop more severe reactions to a lower load of antigenic agent.

The shortness of breath and "chest tightness" were probably from the asthma component of the generalized allergic reaction, and had nothing at all to do with your heart. A physician, who sees that, along with the usual tachycardia and ectopy that one finds in these generalized allergic reactions, might say that there is some left ventricular failure; it's a debatable point, because if the bronchospasm and pulmonary hypertension get severe enough, there would in fact be some LVF, primarily from RVF. It's more mental masturbation than it's worth.

I love the mainland Chinese attitude towards medicine and health in general. "More chicken soup". So unknowing, unsophisticated and simple, yet, so true.

[Chicken]

The summary on the ECG print out stated "Borderline Left Ventricular Failiure"... it flat-lined for more than half of the chart.

At the time, I didn't feel like I was struggling for breath just my breathing became laboured as I was fighting the constriction in the chest to get air. The constriction with the intense pressure was so relatively fleeting (10 mins and like 7 secs pressure), combined with pains in the upper arms and neck and numbness in the fingers and hands... whatever was going on it sent the doctors scurrying to find me a bed and get me on an ECG. Anyway as they said I have no other indications for heart problems, and all other vital statistics were robust, so, it was just a case of stabilising the allergic reaction.

You have just brought it home to me Doc. I've realised on reflection this morning, that I'm well on the slippery slope with iodine... I've never liked seafood, aged 7 I was force-fed some and was extremely ill (can still remember missing New Years Eve celebrations, knees to chest in bed all night). Then last year, I was confronted with what was on all accounts a "delicious fish pie", ... as a child I would happily lose a month's pocket money rather than touch the stuff! Here, it would have been seriously socially ungracious not to eat it, since the friend who prepared it was also juggling a 5 month old baby and 3 year old. I had a horrible night, was throwing up the next morning, on the way back home, I had to stop the car... fortunately the friend I had with me, had in the interim qualified as an MD and was specialising and practising in an ER dept in Sydney.

Sincere thanks Doc... I conclude that you included, the gods have clearly been with me so far! I'll stay away from all things Iodine and Seafood related from now on!

Chicken

[Chicken]

Follow Up

The company that produces the dye is now following up as legally required. It transpires that there is actually very little iodine in the dye, and my reaction in relation to the small quantity implies I'm already highly sensitised to it.
They've advised me to stay strictly away from even a whiff of the stuff, and to even consider giving up fish, in case of cross contaimination with seafood!

I can't imagine life without sushi... so its "Sushi Roulette" for me from now on.

Chicken
~ living on the edge!

[doc]

Carry a little fanny pack around, keep it in your car or something. Keep an Epipen or two in it, along with some tablets of Benadryl 25mg, Prednisone 10mg, Zantac 150mg, and something like Zyrtec (a broad antihistamine). Talk to your doctor about it. It will make living on the edge a little safer.

[Chicken]

Will do, thanks Doc... I'll stock up at the chemist tomorrow.
They think they are going to send me for allergy testing too.
Much happy fun!

Chicken

[doc]

One possible treatment regimen if you're developing an allergic reaction:

One 25mg "allergy free" (no dye) Benadryl. Two if you don't mind falling asleep.
Two to four 10mg Prednisone tablets (get with prescription), depending upon how big you are.
One 150mg Zantac
One 180mg Allegra (I think it's still prescription)

Use of the Epipen if there's evidence of difficulty breathing, talking, inability to phonate high pitched sounds, dizziness...

That should keep you going until medical care arrives. Always keep that stuff with you; I keep that, (and gads more) when I travel. Amazing how many times I've had to help people on airplanes, in restaurants, etc, as a physician.

[tunisia_x]

RE:Allergic Reaction to Contrast Dye

Hey buddy, few days ago I found Benadryl Allergy Dye on internet. It is for those children who are severely allergic to food coloring now are able to take the same effective Benadryl Allergy Liquid without concerns. The same ingredient you have used and trusted for years is now available OTC in this dye - free liquid formula.

[doc]

It's about time. We have a version of it here in Thailand. When you think about the numbers of people that are developing red dye allergies (increased asthma rates, increased red dye allergies), they should have done this a long time ago.

I've got one hell of an experience with red dye allergies. Remind me.