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Despite administration of intravenous glucocorticoid and diphenhydramine at our hospital, the patient had an anaphylactoid reaction during the procedure that was refractory to epinephrine and required intubation and pressor support. We suspect that earlier administration of premedication, especially glucocorticoids, prior to transfer may have improved our patient\u2019s outcome. This case report highlights the importance of vigilance in considering anaphylaxis and the potential role of early administration of premedication in patients with previous ICM reactions to minimise risk of recurrent adverse reactions.<\/jats:p>","DOI":"10.1136\/bcr-2025-266915","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:35:15Z","timestamp":1756902915000},"page":"e266915","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Severe allergic reaction to contrast dye during emergent coronary angiogram"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4644-6910","authenticated-orcid":false,"given":"Jack Armstrong","family":"Bookbinder","sequence":"first","affiliation":[{"name":"School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keshav","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Fitch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Bruckel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"2025090305350805000_18.9.e266915.1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1557(199807\/08)7:4<269::AID-PDS366>3.0.CO;2-3"},{"key":"2025090305350805000_18.9.e266915.2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.162.3.8109489"},{"key":"2025090305350805000_18.9.e266915.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38905.634132.AE"},{"key":"2025090305350805000_18.9.e266915.4","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.jacr.2010.09.001","article-title":"A survey on the use of premedication prior to iodinated and gadolinium-based contrast material administration","volume":"8","author":"O\u2019Malley","year":"2011","journal-title":"J Am Coll Radiol"},{"key":"2025090305350805000_18.9.e266915.5","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.14.13810"},{"key":"2025090305350805000_18.9.e266915.6","unstructured":"ACR manual on contrast media. 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