General informationThis section has been translated automatically.
- Every year, 70 million applications worldwide are performed with iodinated contrast media. Iodinated contrast media are divided into an ionic high osmolar class (e.g. amidotrizoate, meglumin, ioxitalamate) and a non-ionic low osmolar class (e.g. iohexol, iopamidol, Ioversol, Iopramid, Iomeprol, Iopentol, Iobitridol, Iodixanol).
- Iodinated contrast media can cause anaphylactoid reactions within one hour after administration. An IgE-triggered mechanism is often assumed in these cases, but the exact pathophysiological mechanism has not yet been elucidated. Although it is assumed that non-ionic low osmolar contrast media trigger fewer anaphylactoid reactions, in practice, prophylactic medication is still administered for premedication. Delayed reactions have been described in a period of more than 1 hour up to 7 days after contrast agent administration. Pathophysiologically they are mediated by T-cells.
- Gadolinium is a frequently used contrast medium for nuclear spin examinations. The occurrence of nephrogenic systemic fibrosis after the use of gadolinium as contrast medium has been described several times.
OccurrenceThis section has been translated automatically.
Overall, less severe complications occur after exposure to non-ionic low osmolar contrast media, but death rates are similar.
| Prevalence of immediate type hypersensitivity reactions | ||
| Severity of complications | Ionic high osmolar contrast medium | Non-ionic low osmolar contrast media |
| Light | 3,8-12,7% | 0,7-3,1% |
| Heavy | 0,1-0,4% | 0,02-0,04% |
- Prevalence of late type reactions: 0.5-23%.
- fatal outcome: 1/100,000 exposures
- The greatest risk factor for the occurrence of contrast agent intolerance is a previous hypersensitivity reaction. Other risk factors are severe allergies, bronchial asthma, heart disease, mastocytosis, taking beta blockers and autoimmune diseases.
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Clinical pictureThis section has been translated automatically.
- Immediate type reactions: possible are pruritus, urticaria, angioedema, flush, nausea, vomiting, diarrhoea, rhinitis, hoarseness, coughing, shortness of breath, hypotension, tachycardia, arrhythmia, shock, cardiac arrest, respiratory arrest.
- Late type reactions: possible are pruritus, urticaria, angioedema, maculo-papular exanthema, erythema multiforme minor, fixed drug exanthema, Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis, graft-versus-host reaction.
DiagnosisThis section has been translated automatically.
- Prick test with the incriminated contrast medium (undiluted) and alternatively with non-ionic low osmolar contrast medium (undiluted).
- Intracutaneous testing with the accused contrast medium (1:1000 to 1:10 in 0.9% physiological saline solution) and alternatively with non-ionic low osmolar contrast media (1:1000 to 1:10 in 0.9% physiological saline solution).
- Epicutaneous testing with the accused contrast medium (undiluted) and alternatively with non-ionic lowosmolar contrast media (undiluted).
General therapyThis section has been translated automatically.
- In the absence of a radiological alternative and prior immediate or late type reaction to an iodinated contrast medium, as well as in the presence of bronchial asthma, the administration of 32 mg methylprednisolone p.o. is currently recommended 12 and 2 hours prior to renewed administration of contrast medium (guideline of the European Society of Urogenital Radiology). If possible, a non-ionic low osmolar contrast medium which has been tested negative in the skin tests (prick, intracutaneous, epicutaneous) should be given.
- If immediate administration of a new contrast medium is necessary, the combined administration of prednisolone 250 mg i.v., dimetinden 1 ampoule (4 ml injection solution) slowly i.v. and cimetidine 1 ampoule (4 ml injection solution diluted to 10 ml with 0.9% NaCl solution) can be recommended. Strictest indication for children and adolescents.
- Studies on the prophylactic effect of various premedication regimens are still of limited significance. The occurrence of anaphylactoid or anaphylactic reactions when contrast medium is administered again, even under premedication, must be expected in individual cases.
LiteratureThis section has been translated automatically.
- Brockow K, Christiansen C, Kanny G, Clément O, Barbaud A, Bircher A et al (2005) Management of hypersensitivity reactions to iodinated contrast media. Allergy 60: 150-158
- Grobner T (2006) Gadolinum-a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 21: 1104-1108
- Kvedariene V, Martins P, Rouanet L, Demoly P (2006) Diagnosis of iodinated contrast media hypersensitivity: results of a 6-year period. Clin Exp Allergy 36: 1072-1077
Prof. Dr. med. Peter Altmeyer