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IgE-mediated anaphylaxis remains one of the rare but significant events specifically related to contrast agents or drugs used during the perioperative period that can lead to morbidity and mortality. Its clinical diagnosis, initially presumptive, is not always obvious. However, anesthesiologists and radiologists must know the different clinical symptoms heralding anaphylaxis in order to provide the appropriate care management according to the severity of the clinical reaction. Clinical signs are described by the Ring and Messmer four-step grading scale, which also helps to guide care according to the severity of the reaction. Grade I and II reactions are usually not life-threatening. Conversely, Grade III and IV reactions are likely to be life threatening and require immediate resuscitative measures including epinephrine and fluid therapy. Early administration of epinephrine remains the cornerstone of anaphylaxis treatment; the appropriate dose should be administered according to the clinical picture. Biochemical tests, either in vivo or in vitro, including at least tryptase level are measured following the clinical reaction, and may help to prove its pathomechanism. Skin tests remain the gold standard for the detection of IgE-mediated reactions and should be performed according to strict rules. Skin tests remain the cornerstone of the allergological assessment in order to identify the culprit agent, prove the pathomechanism of the reaction and provide advice for further procedures. Accordingly, this review also focuses on the clinical pathway used to reintroduce a contrast agent or a neuromuscular blocking agent in patients having presented a documented anaphylactic response to one of these drugs. Finally, as no preemptive therapeutic strategies have been proven to prevent anaphylaxis during the perioperative or radiological settings, an allergological follow-up in patients having presented an immediate reaction, either in the radiological or in the perioperative settings, is highly recommended in order to prevent further recurrences. [ABSTRACT FROM AUTHOR]

A monograph for the pharmaceutical substance "BARII SULFAS/BARIUM SULFATE" from the fourth edition of "The International Pharmacopoeia" is presented. Barium sulfate is categorized as a radiocontrast medium and described as an odourless, white, heavy, fine powder that is practically insoluble in water and in organic solvents. It is recommended that this substance be kept in a well-closed container. Procedures for performing an identity test and acidity or alkalinity examination of the substance are described.

A monograph for the pharmaceutical substance "PROPYLIODONUM/PROPYLIODONE" from the fourth edition of "The International Pharmacopoeia" is presented. Propyliodone is categorized as a radiocontrast medium and described as a white, or almost white, crystalline powder, that is odourless or almost odourless. It is recommended that this substance be kept in a tightly-closed container, protected from light. Procedures for performing an identity test and assay of the substance are described.

A definition of the term "ionic contrast media," which refers to the triiodobenzene derivatives carrying a negative electrical charge, water soluble only as sodium or meglumine salts, is presented.