Fluorescein


Angiography using fluorescein is a valuable tool for the ophthalmologist in investigating vascular disease in general, and chorioretinitis in particular. However this useful method is not free from risk.
 
Incidence
All adverse reactions: (IV administration): 0.6 to 16.1%.
 
(oral administration): 0.9%.
 
Flushing, itching, hives: 0.5 to 0.6%.
 
Anaphylaxis: 0 to 0.2% (deaths reported).
 
Risk factors
Previous reaction during fluorescein angiogram.
 
Black females (urticaria in one study).
 
Clinical manifestations
General: anaphylactic shock
 
Respiratory: bronchospasm.
 
E.N.T.: sneezing (early symptom of allergy).
 
Cutaneous: pruritus, urticaria, angioedema.
 
Diagnostic methods
Cutaneous testing.
 
False positive in intradermal skin-tests. A positive prick-test with 10% fluorescein solution could predict anaphylactoid reaction to intravenous injection of fluorescein.
 
No specific IgE found.
 
Mechanisms
Unknown.
 
Non-specific histamine release?
 
Management
Premedication may be useful (controversial).
 
Desensitization (0.1 ml 1/1 000 to 1 ml pure) is poorly used.

References

  1. Matsuura M, Ando F, Fukumoto K, Kyogane I, Torii Y, Matsuura M, "Usefulness of the prick-test for anaphylactoid reaction in intravenous fluorescein administration (article in Japanese)", Nippon. Ganka. Gakkai. Zasshi., 1996; 100 (4): 313-7
  2. Jennings B.J, Mathews D.E, "Adverse reactions during retinal fluorescein angiography", J. Am. Optom. Assoc., 1994; 65 (7): 465-71
  3. Rohr A.S, Pappano J.E Jr, "Prophylaxis against fluorescein-induced anaphylactoid reactions", J. Allergy. Clin. Immunol., 1992; 90 (3.1): 407-8
  4. Kwiterovich K.A, Maguire M.G, Murphy R.P, Schachat A.T, Bressler N.M, Bressler S.B, Fine S.L, "Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study", Ophtalmology., 1991; 98 (7): 1139-42

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.