Allergic Reaction to CT Scan w/ Contrast

Texas_wedge said:

Allergic reaction to CT dye

I see you've already received some helpful advice on KIDNEY_ONC.   Perhaps I may add a few extra thoughts?

The first thing to say is that you seem to be very unlucky.   >90% sarcomatoid (the extensive necrosis is bound to be a consequence) is amazing on a fairly small tumor, especially with underlying pRCC which is far less prone to sarcomatous change than chRCC is and less than in clear cell.  The consequence of this is that you will certainly need scans at short intervals (I would say 3-monthly)  and therefore your reaction to the dye is extremely important.

Clearly, for your own benefit you'll need to make sure that your allergic reaction is flagged up to everyone and that every time you have a CT scan it's mentioned to the techniciams beforehand. 

I guess you'll be enquiring thoroughly into non-ionic contrast, 1/2 dose, alternative modalities (e.g. MRI) etc. 

It's unusual to have such a severe reaction after such a time lapse - it usually occurs almost immediately.  You probably ought to stick around the hospital premises for a few hours after a CT scan with contrast, in case of a repeat (it may never happen again but is too serious to gamble on).  Have you hydrated thoroughly after your scans?  This is important to flush the dye out of your body as soon as possible and doing so, if you didn't, might perhaps have averted your frightening experience.

Hmmmm
It seems the more CT scans I have, the more issues I have with the contrast as I have posted about it making me ill before. I have de developed a horrible itchy rash on my neck which has spread to my face, ack, arms, chest and thighs (spotty) this week and cannot figure out why. I had my CT With contrast on Wednesday. I do not know if there is any connection but I do have a dr. Appt on Wednesday as nothing I've tried will get rid of it.

hydrangea said:

Allergic Reaction to CT dye

Thank you so much for replying Texas.  I was hoping you would respond as I have followed you on this site and I believe that you are very knowledgeable in the many aspects of RCC. I appreciate any advice you can send my way.  I have never felt that I was unlucky rather the opposite, lucky that in one month from discovering I had the tumor I had surgery and survived the surgery. (Spent 5 days in the hospital - not the 3 the surgeon said was average). 

Once I received the path report (4 months after surgery) I did become very worried/concerned about the recurrence rate and the  >90% sarcomatoid & the extensive necrosis .  I do see an oncologist every 3 months & urologist every 6 months & scans every 6 months at this time.  You can bet that I will discuss going back to 3 month intervals at my next visit w/ each of them (April).

Both know about the reaction in September and I do have meds prescribed.  When I mentioned MRI after the September episode they said MRI wouldn't give them an accurate picture.  As the days go by and the CT scan is quickly approaching the more nervous I get.  I think I will call one of them this week and ask if I can either get an MRI or 1/2 dose of the dye.  Thanks so much for suggesting that I hang around the hospital for awhile afterwards, I hadn't thought of that but agree that it is a good idea. 

I don't know if this has anything to do with the allergic reaction, but I am allergic to bee stings and always carry an epi-pen.  Way back in 1986 I was stung by a bee and had the exact same reaction and it also was delayed many hours after the bee sting.  I went to bed and woke up in the middle of the night w/ a rash all over, swollen and difficulty breathing.  My husband was out to sea (actually in Scotland on a sub) and my small children woke up and dialed 911.  By the way I LOVE Scotland and was able to visit there several times when my husband was active duty Navy stationed there. 

I can't thank you enough for responding to my posting.  I really appreciate you taking the time.

Take good care,

Diane

 

Ct dye

I had my left kidney removed totaly with a 5cm tumor in May of 2001. I have a ct every 6 months since without dye. My kidney doctor will not allow a ct with contrast because of having only one kidney. My creatinine blood test runs at 1.4 which he is happy with. Even without the dye my test showed in 2008 a tumor on my right ardenal gland and it was removed. What I am trying to say is that the scans are helpful in showing what is devolping without contrast. Ask your kidney doctor. I still have my scans every 6 months next due March 11th, we are watching because new rcc cancer has shown up again in November. I am now on chemo pills and having a touch time with side efforts, vomiting often, on Voltent 4 weeks off a month then tryed Sutent for 2 weeks. I am now waiting to rest my body till the scans next week. Good luck and hope you can use my thoughts.  Bryan

todd121 said:

Me Too

I had my right kidney removed in December. My last blood test my creatinine was 1.6. My doctor won't allow me to have the dye until the creatinine drops below 1.5. My most recent scan was done without contrast. He said it's not as good, but it's ok.

I'm not so sure they need to push you to have the dye. I suppose it will help them to find anything that pops up early (small). What can you do but talk to them? The other thing you can do is get a second opinion! And a third if needed.

Todd

Contrast reaction

Diane, you've had the thoughts of one real expert (Susan) and I hope youwill get help from the resident expert here because this is a case for  MedScanMan  -  Jeff, if you're free, come in please.

A couple more thoughts meantime.  Yes, in the obvious sense, the more scans you have, the more opportunities there are for an allergic reaction.  But also, I believe the evidence suggests that when you've had an adverse reaction the odds get worse, rather than better, with subsequent scans, so it's a good idea to get the set-up right, sooner rather than later.   You could maybe enquire whether your docs would classify this reaction as an anaphylactoid one, or anaphylactic (different kinds of allergic response).

rae_rae said:

Adjusting the contrast

TW,

Evidently I forgot to adjust the contrast as you mentioned last year! I mentioned that I had a lot of tummy issues to the tech and she told me to "drink lots of water". I have an appt. tomorrow (not Wed) about my rash, now that it's starting to feel a little better today (as in not so itchy). Who knows what it could be. I truly hope it isn't from the contrast. I have been on the road traveling a lot for work lately, maybe it's a stress-rash.

Contrast control

Yes, let's settle for labelling it 'road rash' !   Sensible to try to sort out the cause though.  Drinking lots of water both before and after the scan is of major importance .  I try to flush my system out after a CT with dye and so far have had no trouble with it.

NanoSecond said:

Contrast

Even though my creatinine level has always been considered "good" (1.2) my onc will only schedule a CT scan with contrast when I insist on it. He always errs on the side of caution and feels that unless something becomes visible (so far I only have had bone mets) there is no need to take the risk.

Meanwhile many oncs who do insist on contrast also recommend that their patients take N-acetylcysteine (NAC) the day before and of the day of the scan.

N-acetylcysteine (NAC) has been approved by the FDA for use in several types of treatments. It is taken primarily to help protect the kidney and it is a powerful anti-oxidant.

 

Because it is an effective helper in the detoxification process, NAC has been approved by the FDA for treatment of acetaminophen overdose and to help protect the kidneys from the toxic effects of IV contrast used in some CT scans and X-ray studies. Because of glutathione's tremendous importance in keeping the mitochondria healthy in the lungs, kidneys, and brain, NAC is commonly used in the treatment of lung diseases like cystic fibrosis, bronchitis, and asthma.

 

 

"NAC is also the key component in the generation of GABA. GABA (gamma amino butyric acid) is one of the most important inhibitory neurotransmitters. It allows the body to have coordinated, fluid movements, and it helps control impulsive behavior. As an inhibitory neurotransmitter, GABA helps with calming and quieting both physical and mental pain and distress.

 

 

Several neurologists and psychiatrists have asked patients to use one to two grams of NAC each day to support GABA generation in the brain. For some individuals, however, diarrhea occurs at doses more than 500mg per day. But the recommended daily allowance for a 150-pound adult is two grams a day (2000mg/day).

 

 

NAC is also found naturally in a variety of foods, including: poultry, egg yolks, yogurt, red peppers, garlic, onions, broccoli, Brussels sprouts and other cruciferous vegetables.  It is also found in oats, wheat germ, asparagus, and avocado.” – Dr. Terry L. Wahls

 

Contrast

Her food list is interesting in this connection, Neil.   As you may have picked up, I eat all of the foods listed on a regular basis, some of them as daily staple items of diet, and so far, after 5 or 6 scans with contrast I've never had any trace of a reaction. 

Mind you, I'm lucky that my facilities use the latest PET/CT scanners and the most advanced contrast media, which may not be available to all on this forum.  I've never been asked to drink any contrast (just as I never had 'liquid plumbing' before either of my ops), just a pint or two of plain water in the hour or a bit less before the scan.   I'm encouraged to drink plenty soon afterwards to initiate getting the dye out of my body. 

They have all the icu gear on hand if any patient should need it and they have me sit down and wait for a few minutes while they verify the imaging has gone to plan and to let my system settle and display any AEs it's wanting to.   They are quite relaxed about my then jumping in to my car and taking off, knowing I could get back to them or to another hospital within not many minutes if I needed to.  I suppose even over there you have locations that are still not using non-ionic contrast  and still have earlier generation scanners?

There are innumerable good websites on the topic and one I've found good is this one from Wisconsin Uni.

https://www.radiology.wisc.edu/fileShelf/contrastCorner/files/ContrastAgentsTutorial.pdf

I found the bit about delayed reactions on page 5 interesting and potentially useful.

 

aazbell said:

IV Dye

I had the same problem with the dye.  I had 4 or 5 scan and then the reaction.  The oncologist prescribed prednisone & benadryl to take prior to and after the scan, but when I got there the hospital refused to give me the dye.  Not because of the reaction but because I had my kidney removed.  So after waiting an hour and a half and drinking a gallon of water.  They decided that I could not have the dye.  It was the first day of their new policy.  I also have papillary kidney cancer that went into lymph nodes and now in the lungs.  Good luck with the scan. 

 

Rash
My rash is believed to be stress related (aka they have no clue). I was given a shot of steroids and steroid cream. My onc doesn't want me to have IV contrast anymore, just because it's hard on the kidney and with my positive prognosis he doesn't feel it's necessary.

pscott said:

Delayed reaction to CT scan dye

This has happened to me twice now, first time I was told it was a panic attack (increased heart rate, flushing, severe nausea, urgent need to defacate). I had awoken from a deep sleep on the evening of a CT scan to experience all this. Then the same attack 2 days later during sleep. Problem is here in Australia Doctors look at you as if to say " You are joking it is impossible". Maybe the first time I believed them but the second time perhaps 18 months later again following a CT scan with contrast I had a similar experience. This time again twice, 3 and 14 days after the scan but thank God not beng woken from a deep sleep, both happening 1st thing after I got out of bed.

I am a CLL sufferer, just wonder if anyone has had similar experience. The denial by medical staff really annoys me and readin g of other peoples similar experience is very useful. I note very well the comments posted re getting re-hydrated quickly.

There is some risk of kidney damage as well. I would think you'd be well within your rights to refuse the contrast.

I get annoyed at how medical staff seems to push us around at times. The more I interact with them, the more I realize I have the right to say no. Stop it. Take it out. You're not going to stick me there. Etc.

When I had my nephrectomy I shared my room with a fellow that was Stage 4 throat cancer and he was in having chemo. He'd had several rounds. I really admired how he ordered people around and told them what he would and wouldn't eat and what he would and wouldn't do. I want to be just like him in standing up for myself. They had left an IV in my arm "just in case" after my surgery and it was really causing me pain and discomfort and they wouldn't remove it (I had another IV in that was being used, this one was just a backup). I ended up with a thrombosis in that vein in my arm where they left that one in and it tooks months to heal up. I asked them to remove it multiple times and their answer each time was "as soon as we remove it, we'll need it". Is that science? That's called SUPERSTITION. Next time I'll demand they remove it and I'll sign whatever it takes to get it to happen. There's always a fine line between standing up for yourself and making them mad, though. I had a good friend that is a nursing aid, and I heard stories about how they treated patients sometimes that were too combative. Let's just say, it could get difficult to get a blanket or a cup of ice if you get them very angry with you. There has to be a balance I suppose.

Todd