European Radiology

, Volume 27, Issue 7, pp 2886–2893 | Cite as

Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study

  • Hye Jung Park
  • Jung-Won Park
  • Min-Suk Yang
  • Mi-Yeong Kim
  • Sae-Hoon Kim
  • Gwang Cheon Jang
  • Young-Hee Nam
  • Gun-Woo Kim
  • Sujeong Kim
  • Hye-Kyung Park
  • Jae-Woo Jung
  • Jong-Sook Park
  • Hye-Ryun Kang
Contrast Media



To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR).


We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014.


A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR.


In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk.

Key points

In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness.

Changing the implicated ICM can reduce the recurrence of HSR to ICM.

Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.


Contrast media Drug hypersensitivity Hypersensitivity, Immediate Premedication Secondary prevention 



American College of Radiology


Confidence interval


Computed tomography


European Society of Urogenital Radiology


Generalized estimation equation


Hypersensitivity reaction


Iodinated contrast medium


Low-osmolar iodinated contrast medium


Odds ratio



The scientific guarantor of this publication is Hye-Ryun Kang. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. This was a retrospective observational multicentre study.


  1. 1.
    Yang MS, Lee SH, Kim TW, Kwon JW, Lee SM, Kim SH et al (2008) Epidemiologic and clinical features of anaphylaxis in Korea. Ann Allergy Asthma Immunol 100:31–36CrossRefPubMedGoogle Scholar
  2. 2.
    Barrett BJ, Parfrey PS, McDonald JR, Hefferton DM, Reddy ER, McManamon PJ (1992) Nonionic low-osmolality versus ionic high-osmolality contrast material for intravenous use in patients perceived to be at high risk: randomized trial. Radiology 183:105–110CrossRefPubMedGoogle Scholar
  3. 3.
    Steinberg EP, Moore RD, Powe NR, Gopalan R, Davidoff AJ, Litt M et al (1992) Safety and cost effectiveness of high-osmolality as compared with low-osmolality contrast material in patients undergoing cardiac angiography. N Engl J Med 326:425–430CrossRefPubMedGoogle Scholar
  4. 4.
    European Society of Urogenital Radiology. ESUR Contrast Media Guidelines version 8.1 June.3, 2016
  5. 5.
    Davenport MS, Cohan RH, Caoili EM, Ellis JH (2009) Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology 253:372–379CrossRefPubMedGoogle Scholar
  6. 6.
    Freed KS, Leder RA, Alexander C, DeLong DM, Kliewer MA (2001) Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. AJR Am J Roentgenol 176:1389–1392CrossRefPubMedGoogle Scholar
  7. 7.
    Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K (1990) Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 175:621–628CrossRefPubMedGoogle Scholar
  8. 8.
    Schopp JG, Iyer RS, Wang CL, Petscavage JM, Paladin AM, Bush WH et al (2013) Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol 20:299–306CrossRefPubMedGoogle Scholar
  9. 9.
    Abe S, Fukuda H, Tobe K, Ibukuro K (2015) Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium. Eur Radiol. doi: 10.1007/s00330-015-4028-1 Google Scholar
  10. 10.
    Radiology ACo ACR Mannual on Contrast Media Version 10.2 2016. Accessed June. 3, 2016Google Scholar
  11. 11.
    Jingu A, Fukuda J, Taketomi-Takahashi A, Tsushima Y (2014) Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol. BMC Med Imaging 14:34CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Pradubpongsa P, Dhana N, Jongjarearnprasert K, Janpanich S, Thongngarm T (2013) Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome-the results of a 3-year period. Asian Pac J Allergy Immunol 31:299–306CrossRefPubMedGoogle Scholar
  13. 13.
    Bae YJ, Hwang YW, Yoon SY, Kim S, Lee T, Lee YS et al (2013) The effectiveness of automatic recommending system for premedication in reducing recurrent radiocontrast media hypersensitivity reactions. PLoS One 8, e66014CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Masch WR, Wang CL, Davenport MS (2016) Severe allergic-like contrast reactions: epidemiology and appropriate treatment. Abdom Radiol (NY) 41:1632–1639CrossRefGoogle Scholar
  15. 15.
    Edwards IR, Biriell C (1994) Harmonisation in pharmacovigilance. Drug Saf 10:93–102CrossRefPubMedGoogle Scholar
  16. 16.
    Meyboom RH, Hekster YA, Egberts AC, Gribnau FW, Edwards IR (1997) Causal or casual? The role of causality assessment in pharmacovigilance. Drug Saf 17:374–389CrossRefPubMedGoogle Scholar
  17. 17.
    Mervak BM, Davenport MS, Ellis JH, Cohan RH (2015) Rates of breakthrough reactions in inpatients at high risk receiving premedication before contrast-enhanced CT. AJR Am J Roentgenol 205:77–84CrossRefPubMedGoogle Scholar
  18. 18.
    Abe S, Fukuda H, Tobe K, Ibukuro K (2016) Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium. Eur Radiol 26:2148–2154CrossRefPubMedGoogle Scholar
  19. 19.
    Bumbacea RS, Petrutescu B, Bumbacea D, Strambu I (2013) Immediate and delayed hypersensitivity reactions to intravascular iodine based radiocontrast media -- an update. Pneumologia 62:47–51PubMedGoogle Scholar
  20. 20.
    Tan T, Xiang Y, Chang C, Zhou Z (2014) Alteration of regulatory T cells in type 1 diabetes mellitus: a comprehensive review. Clin Rev Allergy Immunol 47:234–243CrossRefPubMedGoogle Scholar
  21. 21.
    Hersoug LG, Linneberg A (2007) The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance? Allergy 62:1205–1213CrossRefPubMedGoogle Scholar
  22. 22.
    Park HJ, Lee JH, Park YH, Han H, Sim DW, Park KH et al (2016) Roflumilast ameliorates airway hyper-responsiveness caused by diet-induced obesity in a murine model. Am J Respir Cell Mol Biol. doi: 10.1165/rcmb.2015-0345OC Google Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Hye Jung Park
    • 1
  • Jung-Won Park
    • 2
  • Min-Suk Yang
    • 3
  • Mi-Yeong Kim
    • 4
  • Sae-Hoon Kim
    • 5
  • Gwang Cheon Jang
    • 6
  • Young-Hee Nam
    • 7
  • Gun-Woo Kim
    • 8
  • Sujeong Kim
    • 9
  • Hye-Kyung Park
    • 10
  • Jae-Woo Jung
    • 11
  • Jong-Sook Park
    • 12
  • Hye-Ryun Kang
    • 13
  1. 1.Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  2. 2.Division of Allergy and Immunology, Department of Internal MedicineYonsei University College of MedicineSeoulKorea
  3. 3.Department of Internal MedicineSMG-SNU Boramae Medical CenterSeoulKorea
  4. 4.Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik HospitalInje University College of MedicineBusanKorea
  5. 5.Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
  6. 6.Department of PediatricsNational Health Insurance ServiceIlsan HospitalKorea
  7. 7.Department of Internal MedicineDong-A University College of MedicineBusanKorea
  8. 8.Department of Internal MedicineKwangju Christian HospitalGwangjuKorea
  9. 9.Department of Internal MedicineKyungpook National University School of MedicineDaeguSouth Korea
  10. 10.Department of Internal MedicinePusan National University School of MedicineBusanKorea
  11. 11.Department of Internal MedicineChung-Ang University College of MedicineSeoulKorea
  12. 12.Soonchunhyang University Bucheon HospitalBucheonKorea
  13. 13.Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulKorea

Personalised recommendations