Acute idiosyncratic systemic reactions (also described as allergy-like or anaphylactoid) are defined as unpredictable reactions that occur within 1 h of contrast medium administration, and are unrelated to the amount of contrast medium above a certain level. This definition aims to distinguish them from chemotoxic reactions, which are dose-related and dependent on the physico-chemical properties of the contrast medium. However, in clinical practice, some reactions such as cardiovascular collapse may be difficult to characterise definitely into one or the other group.
Most of this chapter is concerned with acute idiosyncratic reactions to iodinated contrast media, particularly the factors predisposing to these reactions and the measures that may be taken to prevent them. At the end of the chapter, acute reactions to gadolinium contrast media are also discussed (see also Chap. 23).
Keywords
- Contrast Medium
- Allergy Clin Immunol
- Iodinate Contrast Medium
- Anaphylactoid Reaction
- Nonionic Contrast Medium
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References
ACR Committee on Drugs and Contrast Media (2004) Manual on contrast media, 5th edn. American College of Radiology, Reston, VA
Ansell G, Tweedie MCK, West CR et al (1980) The current status of reactions to intravenous contrast media. Invest Radiol 15(Suppl):S32–S39
Armstrong PA, Pazona JF, Schaeffer AJ (2005) Anaphylactoid reaction after retrograde pyelography despite preoperative steroid preparation. Urology 66:880
Bertrand PR, Soyer PM, Rouleau PJ et al (1992) Comparative randomised double-blind study of hydroxyzine versus placebo as premedication before injection of iodinated contrast media. Radiology 184:383–384
Bettman MA, Heeren T, Greenfield A, Gondey C (1997) Adverse events with radiographic contrast agents: results of the SCVIR Contrast Agent Registry. Radiology 203:611–620
Bush WH, Swanson DP (1991) Acute reactions to intravascular contrast media: types, risk factors, recognition and specific treatment. Am J Roentgenol 157:1153–1161
Caro JJ, Trindade E, McGregor M (1991) The risks of death and severe nonfatal reactions with high-vs low- osmolality contrast media: a meta-analysis. Am J Roentgenol 156:825–832
Choyke PL, Miller Dl, Lotze MT et al (1992) Delayed reactions to contrast media after interleukin-2 immunotherapy. Radiology 183:111–114
Cochran ST, Bomyea K, Sayre JW (2001) Trends in adverse events after iv administration of contrast media. Am J Roentgenol 176:1385–1388
Cohan RH, Ellis JH, Dunnick NR (1995) Use of low-osmolar agents and premedication to reduce the frequency of adverse reactions to radiographic contrast media: a survey of the Society of Uroradiology. Radiology 194: 357–364
Dawson P (2005) Commentary: repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents. Clin Radiol 60:56–57
Dawson P, Sidhu PS (1993) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to intravascular contrast agents? Clin Radiol 48:225–226
Dewachter P, Laroche D, Mouton-Fqaivre C, Clement O (2006) Immediate and late adverse reactions to iodinated contrast media: a pharmacological point of view. Anti-Inflammatory Anti-Allergy Agents Med Chem 5:105–117
Dilman JR, Ellis JH, Cohan RC (2007) Frequency and severity of acute allergic-like reactions to gadolinium-containing IV contrast media in children and adults. Am J Roentgenol 189: 1533–1538
Dilman JR, Ellis JH, Cohan RH, Strouse PJ, Jan SC (2008) Allergic like breakthrough reactions after corticosteroid and antihistamine premedication. Am J Roentgenol 190; 187–190
Dore CJ, Sidhu PS, Dawson P (1994) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to intravascular contrast agents? Clin Radiol 49:583–584
Dore CJ, Sidhu PS, Dawson P (1995) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to intravascular contrast agents? Clin Radiol 50:198–199
Eloy R, Corot C, Belleville J (1991) Contrast media for angiography: physicochemical properties, pharmacokinetics and biocompatibility. Clin Mater 7:89–197
Fink U, Fink BK, Lissner J (1992) Adverse reactions to nonionic contrast media with special regard to high-risk patients. Eur Radiol 2:317–321
Fischer HW, Doust VL (1972) An evaluation of pretesting in the problem of serious and fatal reactions to excretory urography. Radiology 103:497–501
Fishman JE, Aberle DR, Moldawer NP et al (1991) Atypical contrast reactions associated with systemic interleukin-2 therapy. Am J Roentgenol 156:833–834
Freed KS, Leder RA, Alexander C et al (2001) Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. Am J Roentgenol 176:1389–1392
Greenberger PA, Patterson R (1991) The prevention of immediate generalised reactions to radiocontrast media in high-risk patients. J Allergy Clin Immunol 87:867–872
Greenberger PA, Patterson R, Radin RR (1984) Two pre-treatment regimens for high-risk patients receiving radiographic contrast media. J Allergy Clin Immunol 74:540–543
Greenberger PA, Patterson R, Tapio CM (1985) Prophylaxis against repeated radiocontrast media reactions in 857 cases. Arch Intern Med 145:2197–2200
Greenberger PA, Meyers SN, Kramer BL et al (1987) Effects of beta-adrenergic and calcium antagonists on the development of anaphylactoid reactions from radiographic contrast media. J Allergy Clin Immunol 80:698–702
Hartman GW, Hattery RR, Witten DM, Williamson B (1982) Mortality during excretory urography: Mayo Clinic experience. Am J Roentgenol 139:919–922
Hugo PC, Neuberg AH, Newman JS, et al. (1998) Complications of arthrography. Semin Musculoskel Radiol 2:345–348
Idee JM, Pines E, Prigent P, Corot C (2005) Allergy-like reactions to iodinated contrast agents. A critical analysis. Fundam Clin Pharmacol 19:263–281
Jacobs JE, Birnbaum BA, Langlotz CP (1998) Contrast media reactions and extravasation: relationship to intravenous injection rates. Radiology 209:411–416
Jordan RM, Mintz RD (1995) Fatal reaction to gadopentetate dimeglumine. Am J Roentgenol 164:734–744
Katayama H, Yamaguchi K, Kozuka T et al (1990) Adverse reactions to ionic and nonionic contrast media. Radiology 175:621–628
King BF (1999) Intravascular contrast media and premedication. In: Bush WH, Krecke KN, King BF, Bettman MA (eds) Radiology life support (RAD-LS): a practical approach. Arnold, New York, p 15
Kirchin MA, Runge VM (2003) Contrast agents for magnetic resonance imaging: safety update. Top Magn Reson Imag 14:426–435
Lang DM, Alpern MB, Visintainer PF, Smith ST (1991) Increased risk for anaphylactoid reaction from contrast media in patients on ß-adrenergic blockers or with asthma. Ann Intern Med 115:270–276
Lang DM, Alpern MB, Visintainer PF, Smith ST (1995) Gender risk for anaphylactoid reaction to radiographic contrast media. J Allergy Clin Immunol 95:813–817
Laroche D, Aimone-Gastin I, Dubois F, et al. (1998) Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology 209:183–190
Lasser EC, Farr R, Fujimagari IT (1962) The significance of protein binding of contrast media in roentgen diagnosis. Am J Roentgenol 87:338–360
Lasser EC (1987) A coherent biochemical basis for increased reactivity to contrast material in allergic patients: a novel concept. Am J Roentgenol 149:1281–1285
Lasser EC (1994) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to intravascular contrast agents? Clin Radiol 49:582–583
Lasser EC (1995) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to intravascular contrast agents? Clin Radiol 50:199
Lasser EC (2004) The radiocontrast molecule in anaphylaxis: a surprising antigen. Anaphylaxis: Novartis Foundation Symposium 257. Wiley, Chichester, pp 211–225
Lasser EC, Berry CC (1994) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to intravascular contrast agents? Clin Radiol 49:584
Lasser EC, Lang JH, Lyon SG (1981) Glucocorticoid-induced elevations of C1-esterase inhibitor: a mechanism for protection against lethal dose range contrast challenge in rabbits. Invest Radiol 16:20–23
Lasser EC, Berry CC, Talner LB et al (1987) Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material. N Engl J Med 317:845–849
Lasser EC, Berry CC, Mishkin MM et al (1994) Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. Am J Roentgenol 162:523–526
Lasser EC, Lyon SG, Berry CC (1997) Reports on contrast media reactions: analysis of data from reports to the US Food and Drug Administration. Radiology 203:605–610
Leder R (1997) Letter. Am J Roentgenol 169:906–907
Li A, Wong CS, Wong MK et al (2006) Acute adverse reactions to magnetic resonance contrast media — gadolinium chelates. Br J Radiol 79:368–371
Miller SH (1997) Anaphylactoid reaction after oral administration of diatrizoate meglumine and diatrizoate sodium solution. Am J Roentgenol 168:959–961
Morcos SK, Thomsen HS, Webb JAW et al (2001) Prevention of generalised reactions to contrast media: a consensus report and guidelines. Eur Radiol 11:1720–1728
Morcos SK (2005). Acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol 78:686–693
Murphy KJ, Brunberg JA, Cohan RH (1996) Adverse reactions to gadolinium contrast media: a review of 36 cases. Am J Roentgenol 167:847–849
Murphy KP, Szopinski KT, Cohan RH, et al. (1999) Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: a survey of the American Society of Neuroradiology Fellowship Directors. Acad Radiol 6:656–664
Nelson KL, Gifford LM, Lauber-Huber C et al (1995) Clinical safety of gadopentetate dimeglumine. Radiology 196:439–443
Oldham RK, Brogley J, Braud E (1991) Contrast medium ‘recalls’ interleukin-2 toxicity. J Clin Oncol 8:942–943
Palmer FJ (1988) The RACR survey of intravenous contrast media reactions: final report. Austr Radiol 32:426–428
Radhakrishnan S, Manoharan S, Fleet M (2005) Repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents. Clin Radiol 60:58–63
Resuscitation Council (UK) (2008) Emergency treatment of anaphylactic reactions. www.resus.org.uk
Rodriguez RM, Gueant JL, Amone-Gastin I et al (2001) Comparison of effects of ioxaglate versus iomeprol on histamine and tryptase release in patients with ischemic cardiomyopathy. Am J Cardiol 88:185–188
Runge VM (2000) Safety of approved MR contrast media for intravenous injection. J Magn Reson Imag 12:205–213
Seymour R, Halpin SF, Hardman JA et al (1994) Corticosteroid prophylaxis in patients with increased risk of adverse reactions to intravascular contrast agents: a survey of current practice in the UK. Clin Radiol 49:791–795
Shehadi WH (1975) Adverse reactions to intravascularly administered contrast media. Am J Roentgenol 124:145–152
Shehadi WH (1985) Death following intravascular administration of contrast media. Acta Radiol Diagn 26:457–461
Siegle RL, Halvorsen RA, Dillon J et al (1991) The use of iohexol in patients with previous reactions to ionic contrast material. Invest Radiol 26:411–416
Sontum PC Christiansen C, Kasparkova V, Skotland T (1998) Evidence against molecular aggregates in concentrated olutions of X-ray contrast media. Int J Pharm 169:203–212
Thomsen HS, Bush WH (1998) Adverse effects of contrast media: incidence, prevention and management. Drug Safety 19:313–324
Weese DL, Greenberg HM, Zimmern PE (1993) Contrast media reactions during voiding cystourethrography or retrograde pyelography. Urology 41:81–84
Witten DM, Hirsch FD, Hartman GW (1973) Acute reactions to urographic contrast medium. Am J Roentgenol 119:832–840
Wolf GL, Miskin MM, Roux SG et al (1991) Comparison of the rates of adverse drug reactions: ionic contrast agents, ionic agents combined with steroids and nonionic agents. Invest Radiol 26:404–410
Yamaguchi K, Katayama H, Takashima T et al (1991) Prediction of severe adverse reactions to ionic and nonionic contrast media in Japan: evaluation of prestesting. Radiology 178:363–367
Zukiwski AA, David CL, Coan J et al (1990) Increased incidence of hypersensitivity to iodine-containing radiographic contrast media after interleukin-2 administration. Cancer 65:1521–1524
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Webb, J.A.W. (2009). Prevention of Acute Reactions. In: Thomsen, H.S., Webb, J.A.W. (eds) Contrast Media. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-72784-2_7
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