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

  • Kyoung-Hee Sohn
  • Gun-Woo Kim
  • Suh-Young Lee
  • Hyo-Soo Kim
  • Sang-Heon Cho
  • Jung-Kyu HanEmail author
  • Hye-Ryun KangEmail author



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.


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.


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.


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.


Coronary angiography Hypersensitivity Contrast media Prospective studies 



Coronary angiography


Confidence interval


Computed tomography


Hypersensitivity reactions




Iodinated contrast media




Odds ratio



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

Compliance with ethical standards


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).


• prospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Kyoung-Hee Sohn
    • 1
    • 2
  • Gun-Woo Kim
    • 2
    • 3
  • Suh-Young Lee
    • 2
    • 4
    • 5
  • Hyo-Soo Kim
    • 6
  • Sang-Heon Cho
    • 2
    • 4
    • 5
  • Jung-Kyu Han
    • 6
    Email author
  • Hye-Ryun Kang
    • 2
    • 4
    • 5
    Email author
  1. 1.Department of Internal MedicineKyung Hee University Medical CenterSeoulSouth Korea
  2. 2.Institute of Allergy and Clinical ImmunologySeoul National University Medical Research CenterSeoulSouth Korea
  3. 3.Department of Internal MedicineSt. Carollo General HospitalSuncheonSouth Korea
  4. 4.Division of Allergy and Clinical Immunology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
  5. 5.Seoul National University Hospital Regional Pharmacovigilance CenterSeoulSouth Korea
  6. 6.Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea

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