Management of adverse reaction to iodinated radiocontrast media

Article information

J Korean Med Assoc. 2012;55(8):779-790

Publication date (electronic) : 2012 August 16

doi : https://doi.org/10.5124/jkma.2012.55.8.779

Myung Jin Shin, MD ¹, Young Joo Cho, MD ²

¹Department of Radiology, Asan Medical Center, University of Ulan College of Medicine, Seoul, Korea.

²Department of Internal Medicine, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Myung Jin Shin, mjshin@amc.seoul.kr

Received 2012 June 18; Accepted 2012 June 30.

Abstract

Application of iodinated radiographic contrast media (RCM) has increased recently because of the number of computed tomography examinations using RCM is increasing rapidly. The awareness regarding potential adverse reactions due to contrast media and the necessary precautions to be taken is of utmost importance both for radiologists and referring physicians since the adverse reactions including hypersensitivity reactions to RCM are still unpredictable and reported in significantly increasing number among exposed patients year by year. In 2011, Korean guideline for the safe use of RCM was published by the Korean Society of Radiology and Korean Academy of Asthma, Allergy and Clinical Immunology. On behalf of these organizations a committee named Korean Network of Allergists & Radiologists for Research of Radio-contrast Media-associated Adverse Reactions (KOAR³A) was formed and collaborated to develop guidelines. Its major purpose is to provide a clinically practical and evidence-based manual full of useful information regarding patient screening, premedication, recognition of adverse reactions, and emergency treatment of such reactions in daily practice as well as other problems, especially kidney toxicity and endocrine problems in consultation with the corresponding medical specialists.

Keywords: Radiocontrast media; Injection, intravenous; Computed tomography; Adverse drug reaction; Hypersensitivity

References

1. Christiansen C. X-ray contrast media: an overview. Toxicology 2005. 209185–187.

2. Brockow K, Ring J. Classification and pathophysiology of radiocontrast media hypersensitivity. Chem Immunol Allergy 2010. 95157–169.

3. Wolf GL, Arenson RL, Cross AP. A prospective trial of ionic vs nonionic contrast agents in routine clinical practice: comparison of adverse effects. AJR Am J Roentgenol 1989. 152939–944.

4. Caro JJ, Trindade E, McGregor M. The risks of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis. AJR Am J Roentgenol 1991. 156825–832.

5. Vogl TJ, Honold E, Wolf M, Mohajeri H, Hammerstingl R. Safety of iobitridol in the general population and at-risk patients. Eur Radiol 2006. 161288–1297.

6. Gomi T, Nagamoto M, Hasegawa M, Katoh A, Sugiyama M, Murata N, Kunihiro T, Kohda E. Are there any differences in acute adverse reactions among five low-osmolar non-ionic iodinated contrast media? Eur Radiol 2010. 201631–1635.

7. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990. 175621–628.

8. Kim SS, Park CH, Park MJ, Choi SH, Kim YS, Park HW, Chang YS, Shin CS, Oh BH, Min KU, Kim YY, Cho SH. Adverse reactions to radio-contrast media in computed tomography (CT) in general population: incidence and clinical features. Korean J Asthma Allergy Clin Immunol 2007. 27157–161.

9. American College of Radiology. Manual on contrast media v7 2010. cited 2012 Jul 18. Reston (VA): American College of Radiology; Available from: http://www.acr.org/Quality-Safety/Resources/Contrast-Manual.

10. European Society of Urogenital Radiology. SUR guidelines on contrast media: version 7.0 2009. cited 2012 Jul 18. Vienna: European Society of Urogenital Radiology; Available from: http://www.esur.org/Contrast-media.51.0.html.

11. Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY. World Allergy Organization. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol 2011. 127587593593.e1–593.e22.

12. Brockow K, Romano A, Aberer W, Bircher AJ, Barbaud A, Bonadonna P, Faria E, Kanny G, Lerch M, Pichler WJ, Ring J, Rodrigues Cernadas J, Tomaz E, Demoly P, Christiansen C. 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. 64234–241.

13. Brockow K, Ring J. Anaphylaxis to radiographic contrast media. Curr Opin Allergy Clin Immunol 2011. 11326–331.

14. Caimmi S, Benyahia B, Suau D, Bousquet-Rouanet L, Caimmi D, Bousquet PJ, Demoly P. Clinical value of negative skin tests to iodinated contrast media. Clin Exp Allergy 2010. 40805–810.

15. Goksel O, Aydın O, Atasoy C, Akyar S, Demirel YS, Misirligil Z, Bavbek S. Hypersensitivity reactions to contrast media: pre-valence, risk factors and the role of skin tests in diagnosis--a cross-sectional survey. Int Arch Allergy Immunol 2011. 155297–305.

16. Kim SH, Lee SH, Lee SM, Kang HR, Park HW, Kim SS, Cho SH, Min KU, Kim YY, Chang YS. Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur J Radiol 2011. 80363–367.

17. Mayorga C, Sanz ML, Gamboa PM, Garcia BE, Caballero MT, Garcia JM, Labrador M, Lahoz C, Longo Areso N, Lopez Hoyos M, Martinez Quesada J, Monteseirin FJ. Immunology Committee of the Spanish Society of Allergology and Clinical Immunology of the SEAIC. In vitro diagnosis of immediate allergic reactions to drugs: an update. J Investig Allergol Clin Immunol 2010. 20103–109.

18. Korean Society of Radiology. Korean Academy of Asthma, Allergy and Clinical Immunology. Clinical practice guideline of adverse drug reactions to the intravenous iodinated radiocontrast media in Korea 2011. 1st edth ed. Seoul: Korean Society of Radiology; Korean Academy of Asthma, Allergy and Clinical Immunology;

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Figure 1

Intramuscular injection site: anterolateral aspect of mid-thigh.