Korean J Radiol.  2018 Apr;19(2):352-357. 10.3348/kjr.2018.19.2.352.

Incidence of Breakthrough Reaction in Patients with Prior Acute Allergic-Like Reactions to Iodinated Contrast Media according to the Administration Route

• Kim YS
• Choi YH
• Cho YJ
• Lee S
• Yoon SH
• Park CM
• Kang HR

• KMID: 2404933
• DOI: http://doi.org/10.3348/kjr.2018.19.2.352

Abstract

OBJECTIVE
This study assessed the risk of acute allergic-like reactions (AARs) after extravascular administration of iodinated contrast media (ICM) in at-risk patients compared with that after intravascular ICM administration.
MATERIALS AND METHODS
From July 2012 to January 2016, 264 patients with a history of moderate or severe reactions to ICM, with re-exposure to ICM intravascularly or extravascularly were included. The incidence of recurrent AARs after ICM re-exposure were assessed according to the administration routes by reviewing electronic medical records and comparison between the two routes.
RESULTS
Among 264 patients, 244 patients had been subsequently exposed to ICM intravascularly, 7 patients via an extravascular route and 13 patients with dual re-exposure. Of 257 patients with intravascular ICM re-exposure, 87 (33.9%) had mild to severe recurrent AARs and 143 (19.5%) cases of recurrent AARs occurred among 733 cases of intravascular ICM re-exposure on a case-by-case basis. However, there was no case of recurrent ARR after extravascular administration of ICM in 20 patients (45 cases) with ICM administrated extravascularly.
CONCLUSION
For high-risk patients with a history of moderate or severe reactions to ICM, AARs upon extravascular administration of ICM are significantly infrequent compared with intravascular ICM administration.

Keyword

Anaphylaxis; Risk; Premedication

MeSH Terms

Anaphylaxis
Contrast Media*
Electronic Health Records
Humans
Incidence*
Premedication
Contrast Media

Figure

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  Fig. 1 Flow diagram of patient selectionICM = iodinated contrast media

Reference

1. Thomsen HS, Morcos SK. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. Br J Radiol. 2003; 76:513–518. PMID: 12893691.

2. Hunt CH, Hartman RP, Hesley GK. Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: retrospective review of 456,930 doses. AJR Am J Roentgenol. 2009; 193:1124–1127. PMID: 19770337.

3. ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. Ver 10.2. American College of Radiology;2016.

4. Cochran ST, Bomyea K, Sayre JW. Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol. 2001; 176:1385–1388. PMID: 11373197.

5. Brockow K, Christiansen C, Kanny G, Clément O, Barbaud A, Bircher A, et al. ENDA. EAACI Interest Group on Drug Hypersensitivity. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005; 60:150–158. PMID: 15647034.

6. Park EA, Lee W, Kang DK, Kim SJ, Kim YJ, Kim Y, et al. Comparison of iohexol-380 and iohexol-350 for coronary CT angiography: a multicenter, randomized, double-blind phase 3 trial. Korean J Radiol. 2016; 17:330–338. PMID: 27134522.

7. Morcos SK. Acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol. 2005; 78:686–693. PMID: 16046418.

8. Tramèr MR, von Elm E, Loubeyre P, Hauser C. Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ. 2006; 333:675. PMID: 16880193.

9. Lee SY, Yang MS, Choi YH, Park CM, Park HW, Cho SH, et al. Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients. Ann Allergy Asthma Immunol. 2017; 118:339–344.e1. PMID: 28087383.

10. Yoon SH, Lee SY, Kang HR, Kim JY, Hahn S, Park CM, et al. Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy. 2015; 70:625–637. PMID: 25649510.

11. Miller SH. Anaphylactoid reaction after oral administration of diatrizoate meglumine and diatrizoate sodium solution. AJR Am J Roentgenol. 1997; 168:959–961. PMID: 9124149.

12. Gmeinwieser J, Erhardt W, Reimann HJ, Babic R, Speck U, Wenzel-Hora B. Side effects of water-soluble contrast agents in upper gastrointestinal tract. Invest Radiol. 1990; 25(Suppl 1):S27–S28. PMID: 2283247.

13. Pan JJ, Draganov PV. Adverse reactions to iodinated contrast media administered at the time of endoscopic retrograde cholangiopancreatography (ERCP). Inflamm Allergy Drug Targets. 2009; 8:17–20. PMID: 19275689.

14. Skucas J. Anaphylactoid reactions with gastrointestinal contrast media. AJR Am J Roentgenol. 1997; 168:962–964. PMID: 9124150.

15. Witten DM, Hirsch FD, Hartman GW. Acute reactions to urographic contrast medium: incidence, clinical characteristics and relationship to history of hypersensitivity states. Am J Roentgenol Radium Ther Nucl Med. 1973; 119:832–840.

16. Pirmohamed M, Naisbitt DJ, Gordon F, Park BK. The danger hypothesis--potential role in idiosyncratic drug reactions. Toxicology. 2002; 181-182:55–63. PMID: 12505285.

17. Draganov P, Cotton PB. Iodinated contrast sensitivity in ERCP. Am J Gastroenterol. 2000; 95:1398–1401. PMID: 10894570.

18. Mann K, Rendl J, Busley R, Saller B, Seybold S, Hoermann R, et al. Systemic iodine absorption during endoscopic application of radiographic contrast agents for endoscopic retrograde cholangiopancreaticography. Eur J Endocrinol. 1994; 130:498–501. PMID: 8180679.

19. Davis PL. Anaphylactoid reactions to the nonvascular administration of water-soluble iodinated contrast media. AJR Am J Roentgenol. 2015; 204:1140–1145. PMID: 26001221.

20. Park HJ, Park JW, Yang MS, Kim MY, Kim SH, Jang GC, et al. Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: a multicentre retrospective cohort study. Eur Radiol. 2017; 27:2886–2893. PMID: 27975150.

21. Davenport MS, Cohan RH, Caoili EM, Ellis JH. Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology. 2009; 253:372–379. PMID: 19789241.

22. Shehadi WH. Contrast media adverse reactions: occurrence, recurrence, and distribution patterns. Radiology. 1982; 143:11–17. PMID: 7063711.

23. Freed KS, Leder RA, Alexander C, DeLong DM, Kliewer MA. Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. AJR Am J Roentgenol. 2001; 176:1389–1392. PMID: 11373198.

24. Brockow K, Romano A, Aberer W, Bircher AJ, Barbaud A, Bonadonna P, et al. European Network of Drug Allergy and the EAACI Interest Group on Drug Hypersensitivity. Skin testing in patients with hypersensitivity reactions to iodinated contrast media - a European multicenter study. Allergy. 2009; 64:234–241. PMID: 19178403.

25. Sancak S, Jaeschke H, Eren F, Tarcin O, Guellueoglu B, Sen LS, et al. High prevalence of TSHR/Gsα mutation-negative clonal hot thyroid nodules (HNs) in a Turkish cohort. Horm Metab Res. 2011; 43:562–568. PMID: 21773967.

26. Lasser EC, Berry CC, Mishkin MM, Williamson B, Zheutlin N, Silverman JM. Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. AJR Am J Roentgenol. 1994; 162:523–526. PMID: 8109489.

27. Wolf GL, Mishkin MM, Roux SG, Halpern EF, Gottlieb J, Zimmerman J, et al. Comparison of the rates of adverse drug reactions. Ionic contrast agents, ionic agents combined with steroids, and nonionic agents. Invest Radiol. 1991; 26:404–410. PMID: 2055736.