Late adverse reactions to intravascular iodinated contrast media

Abstract

Late adverse reactions to intravascular iodinated contrast media are defined as reactions occurring 1 h to 1 week after contrast medium injection. They have received increasing interest over the past decade, but their prevalence remains uncertain and their pathophysiology is not fully understood. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and to issue guidelines. An extensive literature search was carried out and summarized in a report. Based on the available information, simple guidelines have been drawn up. The report and guidelines were discussed at the 8th European Symposium on Urogenital Radiology in Genoa. Late adverse reactions after intravascular iodinated contrast medium include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. A significant proportion of these reactions is unrelated to the contrast medium; however, allergy-like skin reactions are well-documented side effects of contrast media with an incidence of approximately 2%. Late reactions appear to be commoner after nonionic dimers. The majority of late skin reactions after contrast medium exposure are probably T-cell-mediated allergic reactions. Patients at increased risk of late skin reactions are those with a history of previous contrast medium reaction and those on interleukin-2 treatment. Most skin reactions are self-limiting and resolve within a week. Management is symptomatic and similar to the management of other drug-induced skin reactions.

Feasibility of Detecting Pulmonary Embolism Using Noncontrast MRI

“…CTPA also requires the use of iodinated contrast media and, therefore, has the possibility of contrast reactions [4, 13–15] and exacerbation of renal function impairment. To date, the majority of studies evaluating the use of MRI in the diagnosis of PE have also used IV contrast [7], albeit gadolinium-based rather than iodinated contrast.…”

Fixed Drug Eruption due to Iopromide (Ultravist®)

“…The majority of late skin reactions after contrast media ingestion are probably T cell-mediated allergic reactions5. Memory T cells are probably not circulating and remain only at the lesion, over the residual hyperpigmentation.…”

“…Late reactions to contrast media have been shown to occur more frequently (8%) than immediate reactions (4%)6. The frequency of late adverse reactions to NIM has been reported to be between 0.52~23%5. To the best of our knowledge, there have been only three reports of FDE caused by NIM; iopromide2, iomeprol4, and iopamidol7 in the English literature.…”

“…We recommended that our patient undergo patch testing with other contrast media; however, he did not want further evaluation. Last, in order to prevent cutaneous reactions, patients who have previously undergone a series of FDE to contrast media are recommended to receive administration of intravenous injections of antihistamine and corticosteroid prior to future angiography5,6.…”

A Delayed, Unusual Non-Cardiogenic Pulmonary Edema after Intravascular Administration of Non-Ionic, Low Osmolar Radiocontrast Media for Coronary Angiography

“…Immediate hypersensitivity reactions are usually anaphylactoid reactions that range from rashes and a sensation of flushing to life-threatening severe reactions,1-4) while delayed reactions are predominantly exanthematous skin reactions that are self-limiting 1)3)5)6). Non-cardiogenic pulmonary edema (NCPE) following intravascular injection of RCM is rare.…”