Beta-Blockers, ACE Inhibitors Don’t Raise Anaphylaxis Risk From Cardiac Catheterization

By Will Boggs MD

December 19, 2019

NEW YORK (Reuters Health) - The risk of anaphylactic reactions from contrast media used during cardiac catheterization is not increased in patients on beta-blockers or angiotensin-converting enzyme (ACE) inhibitors, according to results from a retrospective case-control study.

"Now that low-osmolar contrast media (LOCM) has become the standard, it is reassuring that beta-blockers and ACE inhibitors do not seem to pose increased risk for greater rates or severity of anaphylaxis, when used intra-arterially prior to cardiac catheterization," Dr. Martin A. Smith of Cleveland Clinic Foundation, in Ohio, told Reuters Health by email.

Previous studies have linked beta-blockers and ACE inhibitors to a greater risk of more severe anaphylactic reactions in patients exposed to intravenous high-osmolar contrast media.

Dr. Smith's team examined the impact of beta-blocker and ACE inhibitor treatment on the frequency and severity of anaphylactic reactions in the setting of administration of intra-arterial LOCM during left heart catheterization in 46 cases and 86 matched controls.

The overall rate of anaphylactic reactions was 0.064% (with a severe anaphylactic reaction rate of 0.015%), the researchers report in the Journal of Allergy and Clinical Immunology: In Practice.

The rate of beta-blocker use did not differ significantly between cases (57%) and controls (64%), with about 80% of users taking cardioselective beta-blockers, and ACE inhibitor usage was the same for cases and controls.

Neither cardioselective beta-blockers nor non-cardioselective beta-blockers had an influence on the rate or severity of anaphylactic reactions, and neither ACE inhibitors nor angiotensin-receptor blockers (ARBs) had an influence on the rate or severity of anaphylactic reactions.

"Our findings imply that routine suspension of beta-blockers and ACE inhibitors prior to administration of low-osmolar contrast in association with cardiac catheterization is unnecessary," Dr. Smith concluded.

The study had no specific funding, and the authors report no conflicts of interest.

SOURCE: Journal of Allergy and Clinical Immunology: In Practice, online November 1, 2019.