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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

Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusion

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.

Keywords

Contrast media Drug hypersensitivity Hypersensitivity, Immediate Premedication Secondary prevention 

Abbreviations

ACR

American College of Radiology

CI

Confidence interval

CT

Computed tomography

ESUR

European Society of Urogenital Radiology

GEE

Generalized estimation equation

HSR

Hypersensitivity reaction

ICM

Iodinated contrast medium

LOCM

Low-osmolar iodinated contrast medium

OR

Odds ratio

Notes

Acknowledgements

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.

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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

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