Skip to main content

Advertisement

Log in

Allergic-like contrast media reaction management in children

  • Review
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

The use of contrast materials as part of imaging examinations is common in children of all ages, as these compounds increase image contrast, lesion detection and lesion characterization. Though modern iodinated, gadolinium-based and ultrasound microbubble contrast materials generally are quite safe, acute physiological and allergic-like reactions are possible. The majority of acute contrast reactions in children are mild and self-limited; however, life-threatening reactions can occur. It is our obligation as radiologists to recognize and manage these adverse reactions. The objective of this article is to review the frequency, manifestations and appropriate treatment of acute contrast reactions in the pediatric population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American College of Radiology (2017) ACR–SPR practice parameter for the use of intravascular contrast media. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/ivcm.pdf. Accessed 09 Aug 2018

  2. Cohan RH, Dunnick NR (1987) Intravascular contrast media: adverse reactions. AJR Am J Roentgenol 149:665–670

    Article  CAS  PubMed  Google Scholar 

  3. American College of Radiology (2017) ACR manual on contrast media. https://www.acr.org/Clinical-Resources/Contrast-Manual. Accessed 09 Aug 2018

  4. Labbe E, Peyroux T (1984) Mechanisms of adverse reactions to iodinated contrast material. Radiat Med 2:93–100

    CAS  PubMed  Google Scholar 

  5. Lieberman P, Siegle RL, Taylor WW (1978) Anaphylactoid reactions to iodinated contrast material. J Allergy Clin Immunol 62:174–180

    Article  CAS  PubMed  Google Scholar 

  6. Laroche D, Namour F, Lefrancois C et al (1999) Anaphylactoid and anaphylactic reactions to iodinated contrast material. Allergy 54(Suppl 58):13–16

    Article  PubMed  Google Scholar 

  7. Dillman JR, Strouse PJ, Ellis JH et al (2007) Incidence and severity of acute allergic-like reactions to i.v. nonionic iodinated contrast material in children. AJR Am J Roentgenol 188:1643–1647

    Article  PubMed  Google Scholar 

  8. Davenport MS, Dillman JR, Cohan RH et al (2013) Effect of abrupt substitution of gadobenate dimeglumine for gadopentetate dimeglumine on rate of allergic-like reactions. Radiology 266:773–782

    Article  PubMed  PubMed Central  Google Scholar 

  9. Forbes-Amrhein MM, Dillman JR, Trout AT et al (2018) Frequency and severity of acute allergic-like reactions to intravenously administered gadolinium-based contrast media in children. Investig Radiol 53:313–318

    Article  CAS  Google Scholar 

  10. Callahan MJ, Poznauskis L, Zurakowski D, Taylor GA (2009) Nonionic iodinated intravenous contrast material-related reactions: incidence in large urban children's hospital--retrospective analysis of data in 12,494 patients. Radiology 250:674–681

    Article  PubMed  Google Scholar 

  11. Coudray S, Fabre C, Aichoun I, Perez Martin A (2017) Anaphylactic shock with an ultrasound contrast agent. J Med Vasc 42:384–387

    CAS  PubMed  Google Scholar 

  12. Olson MC, Atwell TD, Knudsen JM (2018) Anaphylactic reaction to an ultrasound contrast agent (Lumason) in a patient with systemic mastocytosis. J Clin Ultrasound. https://doi.org/10.1002/jcu.22585

  13. Tang C, Fang K, Guo Y et al (2017) Safety of sulfur hexafluoride microbubbles in sonography of abdominal and superficial organs: retrospective analysis of 30,222 cases. J Ultrasound Med 36:531–538

    Article  PubMed  Google Scholar 

  14. Haussler MD (2010) Safety and patient comfort with iodixanol: a postmarketing surveillance study in 9515 patients undergoing diagnostic CT examinations. Acta Radiol 51:924–933

    Article  PubMed  Google Scholar 

  15. Peterson A, Katzberg RW, Fung MA et al (2006) Acute generalized exanthematous pustulosis as a delayed dermatotoxic reaction to IV-administered nonionic contrast media. AJR Am J Roentgenol 187:W198–W201

    Article  PubMed  Google Scholar 

  16. Khilnani G, Khilnani AK (2011) Inverse agonism and its therapeutic significance. Indian J Pharmacol 43:492–501

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lopez AM (2010) Antihistamine toxicity. In: Tarabar A (ed) Medscape.com, https://misc.medscape.com/pi/iphone/medscapeapp/html/A812828-business.html. Accessed 09 Aug 2018

  18. National Center for Biotechnology Information (2018) PubChem Compound Database; CID=3100 (Diphenhydramine). https://pubchem.ncbi.nlm.nih.gov/compound/3100. Accessed 09 Aug 2018

  19. United States Department of Health and Human Services (2017) Albuterol – Medical Countermeasures Database. https://chem.nlm.nih.gov/countermeasure_albuterol.htm. Accessed 09 Aug 2018

  20. Prescribers Digital Reference, LLC (2018) Albuterol sulfate inhalation solution 0.083% drug information. http://www.pdr.net/drug-summary/Albuterol-Sulfate-Inhalation-Solution-0-083-albuterol-sulfate-1427. Accessed 09 Aug 2018

  21. Keller KA, Bhisitkul DM (1995) Supraventricular tachycardia: a complication of nebulized albuterol. Pediatr Emerg Care 11:98–99

    Article  CAS  PubMed  Google Scholar 

  22. Kemp SF, Lockey RF, Simons FE, World Allergy Organization ad hoc Committee on Epinephrine in Anaphylaxis (2008) Epinephrine: the drug of choice for anaphylaxis-a statement of the world allergy organization. World Allergy Organ J 1:S18–S26

    PubMed  PubMed Central  Google Scholar 

  23. Masch WR, Ellis JH, Wang CL et al (2016) Effect of available intravenous access on accuracy and timeliness of epinephrine administration. Abdom Radiol (NY) 41:1133–1141

    Article  Google Scholar 

  24. Tupper J, Visser S (2010) Anaphylaxis: a review and update. Can Fam Physician 56:1009–1011

    PubMed  PubMed Central  Google Scholar 

  25. Dillman JR, Ellis JH, Cohan RH et al (2008) Allergic-like breakthrough reactions to gadolinium contrast agents after corticosteroid and antihistamine premedication. AJR Am J Roentgenol 190:187–190

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan R. Dillman.

Ethics declarations

Conflicts of interest

Drs. Dillman and Trout receive funding from Guerbet regarding clinical trial design. Dr. Dillman also receives funding from Bracco Diagnostics related to contrast-enhanced ultrasound. Dr. Davenport has no disclosures.

Additional information

CME activity This article has been selected as the CME activity for the current month. Please visit the SPR website at www.pedrad.org on the Education page and follow the instructions to complete this CME activity.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dillman, J.R., Trout, A.T. & Davenport, M.S. Allergic-like contrast media reaction management in children. Pediatr Radiol 48, 1688–1694 (2018). https://doi.org/10.1007/s00247-018-4241-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-018-4241-6

Keywords

Navigation