[Dysphagia] Allergy to barium

[edagd at ath.forthnet.gr (Lukas Dagdilelis)]

Hi
As a radiologist for the past 20 yrs , i never encountered an allergic 
reaction to barium.
It is mentioned though in the comercial packing, that it may cause 
allergic reactions.
I m practicing videofluroscopy of swallowing for the last 8 yrs and 
never occured such a reaction.
Now, as for the substitute materials to barium. Iodine compounds , water 
soluble are another solution in case of known allergy to barium. Of 
course these materials are hyperosmotic in their undiluted comercial 
form, and if aspirated in a substantial amount (that is the crucial 
point, contrary to dr.Cambell's note), they may cause lung oedema. It 
depends of course of the patients lung state (eg COPD) and cardiac 
function. 
I m using these substances prefering  Iopamiro Gastro (commercial trade 
name for Europe) , BRACCO Italy, which has the lowest possible 
osmolality and when diluted in 1:25  W/Iopamiro it effects in a lower 
osmolality and viscosity. Isovue is isosmotic (ideal though expensive), 
Visipaque (GE) is also isosmotic. Some collegues in Sweden use the 
latter, in case of adversion of the patient to barium.
In my experience , I had never a complication such lung edema or death 
with aspirated water soluble iodine contrast media.

Lukas Dagdilelis MD
Radiologist
Dysphagia Management Team
"G.Papanikolau" Gen.Hosp.
Thessaloniki
Greece