Skip to main content
Log in

Anaphylactoid reactions to radiocontrast media

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Adverse reactions to contrast material are a concern because iodinated contrast materials are commonly used drugs. The risk for adverse reaction is 4% to 12% with ionic contrast materials and 1% to 3% with nonionic contrast materials. The risk for severe adverse reaction is 0.16% with ionic contrast materials and 0.03% with nonionic contrast materials. The death rate, one to three per 100,000 contrast administrations, is similar for both ionic and nonionic agents. More than 90% of adverse reactions with nonionic contrast materials are anaphylactoid. The types of severe reactions seen with nonionic contrast administration were initially predominantly anaphylactoid. With the advent of helical CT angiography, the reactions are now predominantly attributable to cardiopulmonary decompensation. With the widespread use of nonionic contrast materials, adverse reactions are now seen less frequently. Skills involved in evaluating and treating adverse reactions are not as frequently used. Periodic reviews and updates of specific treatment plans for various reactions with the physicians and staff who use contrast material are very important to ensure optimal preparedness. The key to successful treatment is preparation and early intervention.

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.

Similar content being viewed by others

References and Recommended Reading

  1. Katayama H, Yamaguchi K, Kozuka T, et al.: Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990, 175:621–628.

    PubMed  CAS  Google Scholar 

  2. Caro JJ, Trindade E, McGregor M: The risk of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis. AJR Am J Roentgenol 1990, 156:825–832.

    Google Scholar 

  3. Cashman JD, McCredie J, Henry DA: Intravenous contrast media: use and associated mortality. Med J Austral 1991, 155:618–623.

    PubMed  CAS  Google Scholar 

  4. Cochran ST, Bomyea K, Sayre JW: Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 2001, 176:1384–1388.Severe reactions seen with nonionic contrast materials were initially predominantly anaphylactoid. They are now predominantly from cardiopulmonary decompensation. Helical CT angiography may play a role in the change.

    Google Scholar 

  5. Lasser EC, Berry CC, Talner LB, et al.: Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material. N Engl J Med 1987, 317:845–849.

    Article  PubMed  CAS  Google Scholar 

  6. Greenberger PA, Patterson R: The prevention of immediate generalized reactions to radiocontrast media in high-risk patients. J Allergy Clin Immunol 1991, 87:867–872.

    Article  PubMed  CAS  Google Scholar 

  7. Freed KS, Leder RA, Alexander C, et al.: Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. AJR Am J Roentgenol 2001, 176:1389–1392.Breakthough reactions to nonionic contrast material occur in 10% of patients, despite steroid premedication. Most breakthrough reactions are mild and similar to the original reaction. Eleven percent increase in severity. If the initial reaction was severe, 17% again experience a severe reaction.

    PubMed  CAS  Google Scholar 

  8. Shehadi WH: Adverse reactions to intravascularly administered contrast media: a comprehensive study based on a prospective survey. AJR Am J Roentgenol 1975; 124:145–152.

    CAS  Google Scholar 

  9. Arora LC, Cochran ST: Adverse reactions to iodinated contrast agents. Radiologist 1999, 6:193–198.

    Article  Google Scholar 

  10. Bush WH, Swanson DP: Acute reactions to intravascular contrast media: types, risk factors, recognition, and specific treatment. AJR Am J Roentgenol 1991, 57:1153–1161.

    Google Scholar 

  11. Lang DM, Alpern MB, Visintainer PF, Smith ST: Increased risk for anaphylactoid reaction from contrast media in patients on beta-adrenergic blocker or with asthma. Ann Intern Med 1991, 115:270–276.

    PubMed  CAS  Google Scholar 

  12. ACR Manual on Contrast Media 2004. Reston, Virginia: American College of Radiology; 2004. Specific prevention and treatment plans for various anaphylactoid and other adverse events associated with administration of contrast material.

  13. Panto PN, Davies P: Delayed reactions to urographic contrast media. Br J Radiology 1984, 59:41–44.

    Article  Google Scholar 

  14. McCullough M, Davies P, Richardson R: A large trial of intravenous Conray 325 and Niopam 300 to assess immediate and delayed reactions. Br J Radiol 1989, 62:260–265.

    PubMed  CAS  Google Scholar 

  15. Cochran ST, Cugley AL, Kioumehr F: Delayed reactions in patients receiving nonionic contrast media. Advances in X-ray Contrast 1993, 1:61–62.

    Google Scholar 

  16. Choyke PL, Miller DL, Lotze MT, et al.: Delayed reactions to contrast media after interleukin-2 immunotherapy. Radiology 1992, 183:111–114.

    PubMed  CAS  Google Scholar 

  17. Zikiwski AA, David CL, Coan J, et al.: Increased incidence of hypersensitivity to iodine-containing radiographic contrast media after interleukin-2 administration. Cancer 1990, 65:1521–1524.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cochran, S.T. Anaphylactoid reactions to radiocontrast media. Curr Allergy Asthma Rep 5, 28–31 (2005). https://doi.org/10.1007/s11882-005-0051-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-005-0051-7

Keywords

Navigation