Hypersensitivity reactions after diagnostic nonvascular administration of iodine-based contrast media and gadolinium-based contrast agents and the role of the drug allergy specialist

• Published in: European journal of radiology 2024-12, Vol.181, p.111803, Article 111803
• Main Authors: van der Molen, Aart J., Vega, Francisco, A.J.M van de Ven, Annick, Dekkers, Ilona A., Laguna, José J.
• Format: Article
• Language: English
• Subjects: Contrast Media - adverse effects; Contrast media/administration and dosage; Drug administration routes; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug Hypersensitivity - prevention & control; Fluoroscopy; Gadolinium - adverse effects; Humans; Hypersensitivity; Iodine - adverse effects; Iodine Compounds - adverse effects; Magnetic resonance imaging; Tomography; X-ray computed
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2024.111803

•The risk of hypersensitivity reactions following the nonvascular administration of contrast media is very low.•Routine use of premedication is no longer recommended.•Changing the culprit contrast medium is the most effective measure to prevent recurrent hypersensitivity reactions.•An allergological analysis is the best approach to select an alternative contrast medium. The risk of hypersensitivity reactions (HSR) following nonvascular administration of contrast media (CM) for diagnostic studies is very low, likely due to minimal absorption into the systemic circulation. Most published individual cases of HSR after nonvascular CM administration are immediate reactions caused by ionic high-osmolar CM, few by nonionic low-osmolar CM, and none by gadolinium-based contrast agents. Measures to prevent recurrent HSR following nonvascular administration are similar to those recommended to prevent HSR after intravascular CM administration. Premedication as preventive measure has been abandoned, while switching to an alternative CM, preferably based on the results of an allergological analysis, is increasingly advocated. In selected scenarios, preventive measures may be minimized.