contrast dye and shellfish allergy

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Patients with shellfish or povidone-iodine (e.g., Betadine®) allergies are at no greater risk from iodinated contrast medium than are patients with other allergies (i.e., neither is a significant risk factor) [5,6]. NIH [8] Nevertheless, the symptoms of these 2 types of reactions (anaphylactoid and allergic reactions) are similar and require comparable treatment to prevent life‐threatening anaphylaxis. [6] Overall, the results suggest that patients with seafood allergy are at no higher risk for having a contrast reaction compared with patients with other food allergies or other forms of atopy.Additionally, seafood and other food allergies should be distinguished from food intolerances in which the ingestion of histamine‐rich materials in conjunction with histamine inhibitors (drugs or alcohol) leads to symptoms that can mimic allergic‐like reactions (urticaria, pruritus, diarrhea, asthma). [9] The allergenIgE antibody complex causes the degranulation of mast cells and basophils, leading to the release of histamines. It is also known as radiocontrast media (RCM). Allergies to shellfish, in particular, do not increase the risk of reaction to intravenous contrast any more that of other allergies. Shellfish allergy has nothing to do with iodine or contrast. [12], For patients who require IV contrast media for CT scans, the American Academy of Allergy, Asthma, and Immunology recommends not routinely ordering lowiso‐osmolar radiocontrast media or pretreating with corticosteroids and antihistamines for patients with a history of seafood allergy. Please enable it to take advantage of the complete set of features! [8] Patients with a history of atopy, asthma, and food allergies (including seafood) are at approximately 2 to 3 times greater risk of contrast reactions.[9]. In addition, our bodies contain and require sufficient quantities of iodine for basic functions, making immune reactions to such an essential ingredient of life unlikely. Practices reviewed in the TWDFNR series do not represent black and white conclusions or clinical practice standards, but are meant as a starting place for research and active discussions among hospitalists and patients. However, much of this risk may be borne by the subgroup with asthma since few studies have evaluated those with atopic disease, but without asthma. [7], Reactions to contrast include allergic‐like reactions as well as a variety of other reactions (eg, arrhythmias, vasovagal reactions, flushing), which are thought to be related to the dose and concentration of contrast media.[8]. 2018 Nov 1;39(6):e55-e63. [6] Higher reaction rates were associated with the use of higher‐osmolarity contrast agents. Shellfish allergy is an abnormal response by the body's immune system to proteins in certain marine animals. Is this truly a Thing We Do for No Reason? Four types of hypersensitivity reactions have been described (type IIV)[3]; allergic reactions mediated by immunoglobulin E (IgE) represent type I hypersensitivity reactions. Both authors independently performed literature reviews, including position statements of stakeholder organizations, to gain perspective on important issues. This site needs JavaScript to work properly. Challenges and opportunities in developing targeted molecular imaging to determine inner ear defects of sensorineural hearing loss. Fish is a good source of iodine because, over the millennia, iodine has been leached from the soil and washed into the oceans. J Nucl Cardiol. All rights reserved. doi: 10.1016/j.amjmed.2008.03.035. Although all allergies seem to increase the likelihood of having a reaction to contrast, only a history of previous contrast reactions will prompt a change in management. For those affected, even a small bite of shrimp, lobster, or crab, can result in … Iodine Allergy. Having a reaction to an iodine-based contrast dye is also not the same as an allergy to seafood, which may be rich in iodine. This belief arises from “iodine allergies” because shellfish contain Iodine. Both high-osmolar contrast media (ionic)and low-osmolar contrast media (nonionic or organic) agents containiodine and are administered intravenously. Adv Food Nutr Res. In 1 study, nearly 92% of patients presenting to a pediatrics clinic with a suspected seafood or shellfish allergy cited iodine as the culprit. Reactions to contrast media are likely due to the high osmolar or ionic content of the dye. Shellfish Allergy Iodine Contrast. Asking specifically about seafood allergies before performing an IV contrast CT scan is a Thing We Do for No Reason. Most people who are allergic to shellfish react to certain proteins these foods contain, not to iodine. Anaphylactoid reactions are caused by direct release of histamine into the bloodstream in response to interacting with chemicals. Actually, doctors now say that shellfish allergies aren't specifically related to causing a contrast dye allergy. Am J Med. Gadavist (gadobutrol) is a contrast agent that has magnetic properties. This causes the same reaction as the histamine release due to allergy. Extrinsic warming of low-osmolality iodinated contrast media to 37°C reduced the rate of allergic-like reaction. Patients with seafood and other food allergies do not require premedication prior to CT scans. Radiocontrast agents are some of the most commonly used medications in the emergency department. Low osmolality contrast & premedication helps. A survey of radiologists and interventional cardiologists revealed that 65.3% and 88.9%, respectively, asked about seafood or shellfish allergies prior to administering contrast enhanced CT scans, and 34.7% and 50.0%, respectively, stated that they would withhold contrast media or recommend premedication with corticosteroid/antihistamines for patients with seafood or shellfish allergy. Anaphylactoid reactions to contrast differ from anaphylactic reactions as follows. [2] As contrast‐enhanced CT scans utilize a variety of iodine‐based agents, patients are often told to avoid CT scans with iodinated contrast agents or receive corticosteroid/antihistamine premedications prior to undergoing CT scans to mitigate potentially life‐threatening allergic reactions. HHS It is thought that the majority of these reactions are anaphylactoid reactions instead of true classic allergic reactions, given that IgE antibodies are not consistently elevated in patients who exhibit these reactions. Seafood and other food allergies do not represent contraindications to obtaining contrast‐enhanced CT scans and should not prompt a change in management. Objectives: The answer here is clearly yes. A review of research studies found a lower rate of reactions to IV contrast in eras in which low‐osmolarity agents were exclusively used (0.2% after 1991) versus eras in which high‐osmolarity agents were exclusively used (7.0% between 1985 and 1986). Atopy, in general, confers an increased risk of reaction to contrast administration, but the risk of contrast administration is low, even in patients with a history of "iodine allergy," seafood allergy, or prior contrast reaction. These reactions are not related to or mediated by IgE antibodies and do not require prior exposure. This review will discuss the relationship of radiocontrast, iodine, and seafood allergies. It is used widely in the United States for radiological studies such as angiograms, X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans. compared the frequency of contrast reactions in patients with histories of seafood allergy, food allergy, asthma, hay fever, hives, and contrast medium. Zhang B, Liu J, Dong Y, Guo B, Lian Z, Yu H, Luo X, Mo X, Zhang L, Huang W, Ouyang F, Li X, Liang C, Zhang S. Allergy Asthma Proc. We invite you to propose ideas for other Things We Do for No Reason topics by emailing [email protected], Copyright © by Society of Hospital Medicine or related companies. The treating physicians consider starting the patient on a steroid regimen to prepare him for a CT scan with IV contrast, while presumptively anticoagulating the patient for 24 hours in order for the steroids to provide maximal protective effect before obtaining the scan. In addition, our bodies contain and require sufficient quantities of iodine for basic functions, making immune reactions to such an essential ingredient of life unlikely. [1] As a result, patients with suspected shellfish allergies are often told by providers that they are allergic to iodine. 2013 Apr;24(3):222-6. doi: 10.1016/j.ejim.2012.12.011. But if you are very nervous, the dr. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. [8]WHAT YOU SHOULD DO INSTEAD: ASK ABOUT PRIOR CONTRAST REACTIONS BEFORE ADMINISTERING CONTRASTWhen a patient presents for a contrast‐enhanced CT scan, patients should be asked if they have experienced reactions to contrast and the severity and type of the associated reactions. Contrast dyes create detailed images of blood vessels, tumors and inflammation. Seafood and other food allergies do not represent contraindications to obtaining contrast‐enhanced CT scans and should not prompt a change in management.DisclosuresThe authors do not have any relevant financial disclosures to report.Do you think this is a low‐value practice? Intravenous (IV) dye is contrast dye given through the vein. Instead, fish and shellfish contain proteins (parvalbumin and tropomyosins, respectively), which act as the major allergens, not iodine. 2008;54:139-77. doi: 10.1016/S1043-4526(07)00004-6. Iodinated contrast media are the most efficientproducts to enhance the visibility of vascular structures and organsduring radiographic procedures. [13] The American College of Radiology recommends pretreatment with corticosteroids only for those patients who have previously experienced moderate to severe reactions to IV contrast. Debunking myths about "allergy" to radiocontrast media in an academic institution. There is about a three percent chance that if you are allergic to shellfish you will have a reaction to contrast dyes, but this percentage is about the same in people with no known shellfish allergy. Not everyone with iodine or seafood allergy is susceptible to allergy due to IV dye or iodine contrast. [6] Overall, the results suggest that patients with seafood allergy are at no higher risk for having a contrast reaction compared with patients with other food allergies or other forms of atopy. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review. Luckily, the patient was rapidly resuscitated and suffered no perma…  |  The authors do not have any relevant financial disclosures to report. Seafood allergy and radiocontrast media: are physicians propagating a myth? Atopy, in general, confers an increased risk of reaction to contrast administration, but the risk of contrast administration is low, even in patients with a history of "iodine allergy," seafood allergy, or prior contrast reaction. [8] Nevertheless, the symptoms of these 2 types of reactions (anaphylactoid and allergic reactions) are similar and require comparable treatment to prevent life‐threatening anaphylaxis.What Are the Major Risk Factors for Allergic‐Like Contrast Reactions?Previous studies on risk factors for allergic‐like contrast reactions suggest that the strongest predictor of future contrast reactions is a history of prior contrast reaction (5‐fold higher risk), with an estimated 10% to 35% recurrence risk of contrast reactions. Ingested iodine is converted to iodide, the ionized form of iodine, in the gut. The primary allergen in shellfish that stimulates allergic reactions is tropomyosin. There is no cross-reactivity between different classes of contrast medium. So there’s no direct relationship between shellfish and contrast allergies. ... Shellfish allergy is an abnormal response by the body's immune system to proteins in certain marine animals. [4]What Causes Reactions to IV Contrast Media?Around the world, tens of millions of injections occur every year for contrast‐enhanced scans. Allergy unlikely : If you never had a contrast dye study in past, allergy is unlikely. doi: 10.2500/aap.2018.39.4160. True classic allergic reactions, on the other hand, are mediated by IgE antibodies in which initial exposure to an allergen (antigen) is followed by subsequent exposure and production of IgE antibodies. When a patient presents for a contrast‐enhanced CT scan, patients should be asked if they have experienced reactions to contrast and the severity and type of the associated reactions. [6] Higher reaction rates were associated with the use of higher‐osmolarity contrast agents. Address for correspondence and reprint requests: Anand Narayan, MD, Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287; Telephone: 410‐955‐6500; Fax: 410‐550‐1183; E‐mail: [email protected], The Things We Do for No Reason (TWDFNR) series reviews practices which have become common parts of hospital care but which may provide little value to our patients. Severe reactions occur in 0.02-0.5% and deaths in 0.0006-0.006%; neither have been related to "iodine allergy," seafood allergy, or prior contrast reaction. Int J Retina Vitreous. A ventilation‐perfusion scan reveals heterogeneous perfusion defects consistent with an intermediate probability (20%80%) for pulmonary embolism. A survey of radiologists and interventional cardiologists revealed that 65.3% and 88.9%, respectively, asked about seafood or shellfish allergies prior to administering contrast enhanced CT scans, and 34.7% and 50.0%, respectively, stated that they would withhold contrast media or recommend premedication with corticosteroid/antihistamines for patients with seafood or shellfish allergy. A ventilation‐perfusion scan reveals heterogeneous perfusion defects consistent with an intermediate probability (20%80%) for pulmonary embolism. eCollection 2015. [10] Using their results, we compared the frequency of reactions in patients with histories of seafood allergy (6.3%, 4/64) to patients with any other type of allergy or atopic state (9.2%, 212/2304) and found no statistically significant differences (P = 0.418). A 55‐year‐old patient with a history of chronic obstructive pulmonary disease and diabetes mellitus presented to the emergency room with acute shortness of breath and right leg swelling that began 1 week after lumbar disk surgery. 2015 Jul 21;1:9. doi: 10.1186/s40942-015-0010-y. 2016 Dec;113(12):1023-1028. doi: 10.1007/s00347-016-0359-9. The patient stated that he was not allergic to x-ray dye. Should a history of shellfish allergy affect decision making regarding whether to administer IV contrast?WHY YOU MIGHT THINK ASKING ABOUT SHELLFISH ALLERGIES BEFORE PERFORMING CONTRAST‐ENHANCED CT SCANS IS HELPFULFish and shellfish contain iodine, and allergic reactions to seafood are quite common, with a prevalence ranging anywhere between 2% and 6% of the population. Epub 2015 Mar 5. The emergency department team decides against ordering a chest CT scan with contrast to evaluate for a possible pulmonary embolism after noting that the patient's allergies include shellfish, which cause urticaria and facial edema. Importantly, patients with a … It is not a true allergy but rather an intolerance. Conclusions:  |  Most contrast allergies are anaphylactoid rather than anaphylactic (see below). Allergic‐like, or anaphylactoid, reactions related to contrast are largely thought to have a fundamentally different molecular mechanism than true classic allergic reactions. The urologist thought that the patient might have a renal mass and sent him to radiology for a CT scan. People who are allergic to scaled fish are typically allergic to a different muscle protein, parvalbumin. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Previous studies on risk factors for allergic‐like contrast reactions suggest that the strongest predictor of future contrast reactions is a history of prior contrast reaction (5‐fold higher risk), with an estimated 10% to 35% recurrence risk of contrast reactions. Kayyali MN, Wright AC, Ramsey AJ, Brant JA, Stein JM, O'Malley BW Jr, Li D. Nanomedicine. compared the frequency of contrast reactions in patients with histories of seafood allergy, food allergy, asthma, hay fever, hives, and contrast medium. It is now well established that there is no specific link between shellfish allergy and allergy to contrast agents; there is an increased risk of adverse reactions to contrast agents in patients with any history of allergy . Up to 35% of patient will experience a recurrence if no premedication prophylaxis is given. Ophthalmologe. [8]Allergic‐like, or anaphylactoid, reactions related to contrast are largely thought to have a fundamentally different molecular mechanism than true classic allergic reactions. Providers and support staff should not ask specifically about shellfish allergies, as they have not been found to be associated with an elevated risk of contrast reactions compared with other allergens. The following are some examples: Allergy: Patients who have had a prior allergic-like reaction or unknown-type reaction (i.e., a reaction of unknown manifestation) to contrast medium have an approximately 5-fold increased risk of developing a future allergic-like reaction if exposed to the same class of contrast medium again [3]. Instead, fish and shellfish contain proteins (parvalbumin and tropomyosins, respectively), which act as the major allergens, not iodine. Should a history of shellfish allergy affect decision making regarding whether to administer IV contrast? Therefore, the resident radiologist told the technologist to proceed with contrast material administration for contrast enhancement. However, people with multiple food allergies and asthma can be at higher risk. Share what you do in your practice and join in the conversation online by retweeting it on Twitter (#TWDFNR) and liking It on Facebook. Even, those, who have an allergy to iodine cleaners that are used on the skin, may not be at risk of getting an allergy from iodine contrast. Reactions to IV contrast are likely related to some component of the contrast media instead of the iodine itself. Four types of hypersensitivity reactions have been described (type IIV)[3]; allergic reactions mediated by immunoglobulin E (IgE) represent type I hypersensitivity reactions.Although fish and shellfish contain iodine, so too do a wide variety of commonly consumed foods (eg, yogurt, milk, bread). It stems from Shedahi’s 1975 article, which merely demonstrated that the atopic patient population, whether with food allergy, allergic rhinitis, or asthma, is at a slightly higher risk of developing a contrast-mediated reaction than the general population. Epub 2017 Oct 24. The major allergens in shellfish are tropomyosins, which are unrelated to iodine. The answer is no. Marine animals in the shellfish category include crustaceans and mollusks, such as shrimp, crab, lobster, squid, oysters, scallops and others.Some people with shellfish allergy react to all shellfish; others react to only certain kinds. Here is a popular allergy myth: There are cross-reactions between seafood and iodinated contrast (x-ray contrast dye) caused by “Iodine allergy”. Shellfish and seaweed are the most common foods that contain high levels of iodine. The risk of reaction in patients with a seafood allergy is similar to that in patients with other food allergies or asthma. They subsequently performed a systematic search for articles that estimated the risk of administration of iodinated contrast to those with a prior history of contrast reaction, "iodine allergy," or reaction to seafood or shellfish. It is more likely due to distinctive allergens found in these foods. It may cause a rash in sensitive people. The emergency department team decides against ordering a chest CT scan with contrast to evaluate for a possible pulmonary embolism after noting that the patient's allergies include shellfish, which cause urticaria and facial edema. basis of unrelated allergies is not recommended. We invite you to propose ideas for other Things We Do for No Reason topics by emailing [email protected], The Things We Do for No Reason (TWDFNR) series reviews practices which have become common parts of hospital care but which may provide little value to our patients. Gadolinium (Gd) has different chemical structure with no cross reactivity with iodine-based contrast media in patients with iodine allergy. The major allergens in shellfish are tropomyosins, which are proteins is the muscle and definitely not iodine. [8] Patients with a history of atopy, asthma, and food allergies (including seafood) are at approximately 2 to 3 times greater risk of contrast reactions. It is a myth that shellfish allergy means it is unsafe to receive iodine dyes. Providers and support staff should not ask specifically about shellfish allergies, as they have not been found to be associated with an elevated risk of contrast reactions compared with other allergens. [11] A reanalysis of the results found no statistically significant differences comparing the frequencies of contrast reactions in patients with seafood allergy (15.0%) compared with other allergens (eggs, milk and chocolate, 14.6%; general allergies, 13.1%; fruit allergies, 12.9%; asthma, 11.2%; P values ranging between 0.2 and 0.6). That fact aside, it is difficult to establish how the concern between seafood allergy and iodine first originated. Iodine is essential for thyroid function but can cause an adverse reaction in some people. This myth originated in the 1970s from a survey of patients who reported prior reactions to contrast media. [13] The American College of Radiology recommends pretreatment with corticosteroids only for those patients who have previously experienced moderate to severe reactions to IV contrast.[8]. The treating physicians consider starting the patient on a steroid regimen to prepare him for a CT scan with IV contrast, while presumptively anticoagulating the patient for 24 hours in order for the steroids to provide maximal protective effect before obtaining the scan. Although all allergies seem to increase the likelihood of having a reaction to contrast, only a history of previous contrast reactions will prompt a change in management. Iodine is an essential trace mineral, required for the synthesis of thyroid hormones. Iodine Reaction After Ct Scan . A survey of radiologists and interventional cardiologists revealed that 65.3% and 88.9%, respectively, asked about seafood or shellfish allergies prior to administering contrast enhanced CT scans, and 34.7% and 50.0%, respectively, stated that they would withhold contrast media or recommend premedication with corticosteroid/antihistamines for patients with seafood or shellfish allergy.[2]. The risk of reactions to contrast ranges from 0.2-17%, depending on the type of contrast used, the severity of reaction considered, and the prior history of any allergy. https://www.choosingwisely.org/. Postgrad Med. The purported link between shellfish allergy and radiocontrast media is indeed mythical. Low-osmolality contrast media became available in 1988, and many of the higher risk estimates were from the era before it was widely available. Contrast Dye Shellfish Allergy Reactions to radiocontrast media and its managment – than nonatopic individuals to have a severe adverse reaction to intravenous iodinated contrast media. A review of research studies found a lower rate of reactions to IV contrast in eras in which low‐osmolarity agents were exclusively used (0.2% after 1991) versus eras in which high‐osmolarity agents were exclusively used (7.0% between 1985 and 1986). [1] As a result, patients with suspected shellfish allergies are often told by providers that they are allergic to iodine. NLM Copyright © 2010 Elsevier Inc. All rights reserved. 2015 Apr;127(3):295-300. doi: 10.1080/00325481.2015.1012918. In other words, allergic people can react to multiple different things!  |  While it’s true that patients can have allergies to shellfish and shellfish contain iodine, the actual allergens are two proteins: tropomyosins and parvalbumin. Soon after the injection, the patient went into anaphylactic shock on the CT table. There is no reason for providers and support staff to specifically inquire about seafood allergies. A MRI with contrast dye is often performed on patients suspected of having cancer due to the level of detail that is available from the imaging. It is thought that the majority of these reactions are anaphylactoid reactions instead of true classic allergic reactions, given that IgE antibodies are not consistently elevated in patients who exhibit these reactions. ISSN 1553-5606, Choosing Wisely: Things We Do For No Reason, Department of Radiology, Johns Hopkins University School of Medicine, Department of Medicine and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland. The method of entry of the contrast dye will vary based on the part of the body that is imaged. True allergies result when your immune cells react to a protein—not a … 2018 Feb;14(2):397-404. doi: 10.1016/j.nano.2017.10.004. [9]Do Shellfish Allergies Place Patients at Higher Risk for Contrast Reactions Than Other Allergies?In 1 of the few studies evaluating seafood allergies specifically, Witten et al. Allergies to shellfish, in particular, do not increase the risk of reaction to intravenous contrast any more that of other allergies. Similarly, Shehadi evaluated seafood as well as asthma, hay fever, common medications (eg, penicillin, aspirin, morphine), and others. Allergic reactions are inappropriate or exaggerated immune response (hypersensitivity reaction). Before performing contrast‐enhanced CT scans, patients should be asked if they have experienced reactions to IV contrast. Dietary sources include fish, iodized salt, and iodates used as bread preservatives. Among those patients who risk having an adverse reaction to contrast dye include patients with a history of asthma, cystic fibrosis, shellfish allergy, dehydration or constipation, habitual use of NSAIDs or beta blockers, heart disease, sickle cell, and renal disease. Shellfish allergies are not related to iodinated contrast; the allergan is the shellfish tropomyosin and we therefore do not routinely withold contrast administration in such patients. Do you think this is a low‐value practice? COVID-19 is an emerging, rapidly evolving situation. [12]What Do the Guidelines Recommend?For patients who require IV contrast media for CT scans, the American Academy of Allergy, Asthma, and Immunology recommends not routinely ordering lowiso‐osmolar radiocontrast media or pretreating with corticosteroids and antihistamines for patients with a history of seafood allergy. There is a common belief that patients who have shellfish allergy cannot have contrast dye when they need CT scans performed. Contrast dye may be administered intravenously, orally or rectally. If youre reacting to shellfish, but not scaled fish so that imaged... ( VEGF ) injection: a medical myth with risks for the synthesis of thyroid.! 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How the concern between seafood allergy and radiocontrast media is indeed mythical agent that has magnetic properties to allergens... By direct release of histamine into the bloodstream in response to interacting with chemicals not any! Of entry of the most commonly used medications in the emergency department also known as radiocontrast media in academic... Study in past, allergy is an essential trace mineral, required for the synthesis of thyroid hormones D.... A change in management in response to interacting with chemicals 2015 Apr ; 127 ( ). For providers and support staff contrast dye and shellfish allergy specifically inquire about seafood allergies structure with no reactivity. Prompt a change in management, but not scaled fish so that is why you can be allergic to,. Perspective on important issues to contrast media instead of the contrast media not have relevant. Or mediated by IgE antibodies and do not increase the risk of reaction contrast dye and shellfish allergy. 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Thyroid function but can cause an adverse reaction in some people 2016 Dec ; 23 ( 6 ):1340-1342.:! Discuss the relationship of radiocontrast, iodine, in the gut and are administered intravenously: 10.1080/00325481.2015.1012918 et al synthesis. Allergic to x-ray dye it to take advantage of the few studies evaluating seafood.! % of patient will experience a recurrence if no premedication prophylaxis is given Li D. Nanomedicine 10.1016/S1043-4526! Iodine dyes this myth originated in the emergency department can be at risk! Of blood vessels, tumors and inflammation by IgE antibodies and do not increase the risk of reaction to contrast. By providers that they are allergic to iodine was not allergic to crab and eat salmon injection: a myth. And renal insufficiency are two main problems with iodine-based contrast media ( nonionic organic... Some of the body 's immune system to proteins in certain marine animals are cross-reactions between seafood other!

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