Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154 539 Patients

Abstract

Background: With the widespread use of gadolinium-based contrast agents (GBCAs), the incidence of allergic-like hypersensitivity reactions (HSRs) to GBCAs is increasing. Research on the incidence and risk factors for HSRs to GBCAs is needed for their safe use. Purpose:To determine the incidence of acute and delayed reactions to GBCAs and to discuss the risk factors and strategies for the prevention of HSRs to GBCAs. Materials and Methods:All cases of HSRs to contrast media that occurred at the Seoul National University Hospital from July 1, 2012, to June 30, 2020, were assessed. Information including age, sex, GBCA type, onset, and severity of HSRs was retrospectively analyzed.Results: Among the 331 070 cases of GBCA exposure in 154 539 patients, 1304 cases of HSRs (0.4%) were reported. Acute HSRs accounted for 1178 cases (0.4%), while 126 cases (0.04%) were delayed HSRs. While both premedication (odds ratio [OR] = 0.7, P = .041) and changing the type of GBCA (OR = 0.2, P , .001) showed preventative effects in patients with a history of acute HSRs, only premedication (OR = 0.2, P = .016) significantly reduced the incidence of HSRs in patients with a history of delayed reactions. The risk of an HSR to GBCA was higher in those with a history of an HSR to iodinated contrast media (OR = 4.6, P , .001). Conclusion:The rate of hypersensitivity reactions (HSRs) to gadolinium-based contrast agents (GBCAs) was 0.4%. The absence of premedication, repeated exposures to the culprit GBCA, and a history of HSRs to iodinated contrast media and GBCAs were risk factors for HSRs to GBCAs.

Where does the gadolinium go? A review into the excretion and retention of intravenous gadolinium

“…Despite their potential association with GDD, the rate of hypersensitivity reactions to GBCAs remains low. In a review of 331,070 cases of GBCA exposure in 154,539 patients over an 8‐year period at a single institution, investigators found an overall adverse reaction rate of 0.4% ( n = 1304) in patients evaluated soon after GBCA administration, 32 of which 0.4% ( n = 1175) were classified as mild, 0.04% ( n = 117) as moderate and 0.004% ( n = 12) as severe. In contrast, rates of adverse reactions to iodinated contrast media range from 1% to 12%, of which 0.01–0.2% are considered serious adverse reactions 33…”

Diagnosis and Prevention of Hypersensitivity Reactions to Iodinated Contrast Media

“… 16 17 18 Recently, a history of hypersensitivity to gadolinium contrast agents has also been reported as a risk factor for hypersensitivity to ICMs. 19 …”

Contrast allergies for neurological imaging: When to proceed

“…The use of premedication is controversial [ 20 , 22 , 28 , 40 , 44 , 48 , 52 , 77 , 78 , 81 – 84 ]. Studies have shown that premedication is useful in reducing the incidence of, but not preventing, immediate and non-immediate reactions to contrast [ 22 , 52 , 80 , 85 – 87 ]. Furthermore, patients can still have life threatening reactions despite premedication, and contrast should be used with caution in patients with a history of reaction [ 22 , 52 , 73 ].…”