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Immediate and delayed hypersensitivity after intra-arterial injection of iodinated contrast media: a prospective study in patients with coronary angiography

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A Correction to this article was published on 18 February 2020

This article has been updated

Abstract

Objectives

While hypersensitivity reactions (HSR) to intravenously administered iodinated contrast media (ICM) have been well studied, not much is known about HSR to intra-arterially administered ICM.

Methods

A prospective observational study was performed to evaluate coronary angiography (CAG)-induced ICM hypersensitivity in patients who underwent CAG using ICM including ioversol, a low-osmolar non-ionic monomer, and iodixanol, an iso-osmolar non-ionic dimer. The HSR were investigated through in-patient monitoring after CAG and telephone interview after discharge.

Results

A total of 714 patients were enrolled during the observation period, of whom 26 (3.6%) showed immediate HSR and 108 (15.1%) showed delayed HSR. With regard to severity, proportion of immediate HSR grades 1, 2, and 3 was 57.7%, 38.5%, and 3.8%, respectively, whereas that of delayed HSR grades 1, 2, and 3 was 85.2%, 13.9%, and 0.9%, respectively. Multivariate analysis revealed that previous intra-arterial exposure to ICM was an independent risk factor for immediate HSR (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.22–6.96; p = 0.015). Iodixanol was a significant risk factor for delayed HSR (OR 1.61, 95% CI 1.07–2.43; p = 0.024) and correlated with a higher incidence of delayed HSR within 24-h post-ICM administration compared to ioversol.

Conclusion

The incidence rate of immediate and delayed HSR in intra-arterially administered ICM was 3.6% and 15.1%, respectively. Previous exposure to intra-arterially administered contrast media was a significant risk factor for immediate HSR. Compared to ioversol, iodixanol was associated with relatively earlier and more frequent delayed HSR.

Key Points

• In this prospective study, the incidence of immediate and delayed hypersensitivity in intra-arterial injection of contrast media during coronary angiography was 3.6% and 15.1%, respectively.

• Delayed hypersensitivity reactions were more common but less severe than immediate hypersensitivity reactions during coronary angiography.

• Previous exposure to ICM via intra-arterial route was a significant risk factor for immediate hypersensitivity to intra-arterial contrast medium.

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Change history

  • 18 February 2020

    The original version of this article, published on 01 April 2019, unfortunately contained a mistake. The presentation of Fig. 1 was incorrect. The corrected figure is given below.

Abbreviations

CAG:

Coronary angiography

CI:

Confidence interval

CT:

Computed tomography

HSR:

Hypersensitivity reactions

IA:

Intra-arterial

ICM:

Iodinated contrast media

IV:

Intravenous

OR:

Odds ratio

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea

    Kyoung-Hee Sohn

  2. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea

    Kyoung-Hee Sohn, Gun-Woo Kim, Suh-Young Lee, Sang-Heon Cho & Hye-Ryun Kang

  3. Department of Internal Medicine, St. Carollo General Hospital, Suncheon, South Korea

    Gun-Woo Kim

  4. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea

    Suh-Young Lee, Sang-Heon Cho & Hye-Ryun Kang

  5. Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, South Korea

    Suh-Young Lee, Sang-Heon Cho & Hye-Ryun Kang

  6. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea

    Hyo-Soo Kim & Jung-Kyu Han

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  1. Kyoung-Hee Sohn
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Corresponding authors

Correspondence to Jung-Kyu Han or Hye-Ryun Kang.

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Guarantor

The scientific guarantor of this publication is Hye-Ryun Kang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained (the Institutional Review Board of Seoul National University Hospital (IRB No. 1412-052-632).

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• prospective

• observational

• performed at one institution

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Sohn, KH., Kim, GW., Lee, SY. et al. Immediate and delayed hypersensitivity after intra-arterial injection of iodinated contrast media: a prospective study in patients with coronary angiography. Eur Radiol 29, 5314–5321 (2019). https://doi.org/10.1007/s00330-019-06138-3

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  • DOI: https://doi.org/10.1007/s00330-019-06138-3

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