Allergic Reactions

Because of the possibility of angioedema or bronchospasm, each patient with evidence of an allergic reaction should be examined for stridor and wheezing by auscultating over the neck and chest while the patient breathes normally. Minor reactions like urticaria can be treated with oral antihistamines; however, if stridor is present, an intramuscular injection of diphenhydramine and intravenous corticosteroids should be administered. Bronchospasm is estimated to occur postsclerotherapy in 0.001% of patients [2] and responds to inhaled bronchodilators or IV aminophylline. Four types of potentially serious systemic reactions specific to the type of sclerosing agent used have been noted: anaphylaxis, pulmonary toxicity, cardiac toxicity, and renal toxicity [2]. Anaphylaxis is usually IgE mediated, mast-cell derived, and occurs within minutes of exposure to the offending agent. Clinical manifestations include airway edema, bronchospasm, and vascular collapse. Since the risk of anaphylaxis increases with repeated exposures to the antigen, the phlebologist should always be prepared for this reaction in every patient. Initial signs and symptoms may be subtle and can include anxiety, itching, sneezing, coughing, urticaria and angioedema, wheezing, and vomiting, progressing to vascular collapse and cardiovascular failure. Recommended treatment at the onset of symptoms includes epinephrine 1:1,000 subcutaneously injected (0.2–0.5 ml) repeated three to four times at 5–15-min intervals. Emergency medical services should be immediately sought as well. Rarely has anaphylaxis resulted in fatality. There have been no reports of pleural effusion with injection into varicose veins of the legs.