Background: The utilization of iodine contrast media for ERCP to visualize the pancreatobiliary system raises concerns about potential adverse allergic reactions in individuals with a shellfish allergy. This apprehension stems from the misconception that shellfish, containing iodine, may cross-react with iodinated contrast media. Consequently, physicians often resort to premedication and express reservations, leading to delayed imaging and increased healthcare costs. Despite studies questioning the utility of premedication and the controversial impact of seafood allergy on contrast use decisions, this study aimed to compare ERCP outcomes in patients with and without shellfish allergy.
Methods & Materials: Adult patients (Age ≥18) undergoing ERCP at a teaching hospital and its outpatient clinic were screened for inclusion. The primary outcome was the rates of post-operative and intraoperative complications. The secondary outcome was to compare the total recovery, fluoroscopy, and procedure time.
Results: Among the 512 participants, 35 (6.8%) had shellfish allergy, while 477 (93.2%) did not. No significant differences were observed in demographics, procedure indications, or most laboratory tests, except for higher preprocedural platelet levels in those with shellfish allergy (205x10⁹/L vs. 254x10⁹/L; p < 0.05). Patients with shellfish allergy exhibited a higher incidence of pulmonary disease (54.3% vs. 23.6%; p < 0.001). However, there were no notable distinctions between the two groups in intraprocedural hypotension, hypoxemia, rates of periprocedural complications, or recovery/fluoroscopy/total procedure time.
Discussion: Shellfish allergy did not correlate with an increased risk of intra- or post-procedural complications in ERCP. Despite higher preprocedural platelet count and a greater incidence of pulmonary disease in those with a documented shellfish allergy, these factors did not significantly impact procedural outcomes. The study challenges the routine practice of premedicating and avoiding iodinated contrast media in patients with shellfish allergy, suggesting that such precautions may contribute to unnecessary delays and heightened costs without clear benefits in ERCP procedures.

Abhishek Chouthai

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