Contrast Media

European Radiology

, 21:2305

First online:

Late adverse reactions to intravascular iodine based contrast media: an update

  • Marie-France BellinAffiliated withService de Radiologie Générale Adultes, Hôpital de Bicêtre, Secteur Paul Broca
  • , Fulvio StaculAffiliated withS.C. Radiologia Ospedale Maggiore
  • , Judith A. W. WebbAffiliated withDepartment of Radiology, St. Bartholomew’s Hospital, University of London
  • , Henrik S. ThomsenAffiliated withDepartment of Diagnostic Sciences, Faculty of Health Sciences, University of CopenhagenDepartment of Diagnostic Radiology, Copenhagen University Hospital Herlev Email author 
  • , Sameh K. MorcosAffiliated withDepartment of Diagnostic Imaging, Northern General Hospital
  • , Torsten AlménAffiliated with
  • , Peter AspelinAffiliated withDepartment of Radiology, Karolinska Universitets sjukhus
  • , Olivier ClementAffiliated withService de Radiologie, Höpital Européen Georges Pompidou
  • , Gertraud Heinz-PeerAffiliated withDepartment of Radiology, University Hospital Vienna, AKH
    • , Peter ReimerAffiliated withRadiology, Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg
    • , Aart van der MolenAffiliated withDepartment of Radiology -C2-S, Leiden University Medical Center
    • , on behalf of the Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR)

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Late adverse reactions (LAR) to contrast media (CM) are defined as reactions occurring 1 h to 1 week after exposure.

Need for review

In view of more prospective studies of LAR and new data about their pathophysiology, the Contrast Medium Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) reviewed the literature on LAR and updated their guidelines.

Clinical features and pathology

LAR after CM include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. Skin reactions are well-documented LAR to CM with an incidence of approximately 2%–4% after nonionic monomers. LAR are commoner by a factor of three to four after nonionic dimers. The commonest skin reactions are maculopapular rashes, erythema and skin swelling. These reactions are T cell-mediated immune reactions, and the diagnosis may be confirmed using skin tests (patch or delayed reading intradermal). The main risk factors for LAR are a previous reaction to contrast medium, a history of allergy, and interleukin-2 treatment. Most skin reactions are mild or moderate and self-limiting.


Management is symptomatic and similar to the management of other drug-induced skin reactions. To reduce the risk of repeat reactions avoidance of the relevant CM and any cross-reacting agents identified by skin testing is recommended.


Iodine based contrast media Late adverse reactions Skin rash Monomers Dimers