Radiocontrast Media Allergic Reactions and Interventional Pain Practice—A Review

Abstract

Background: Millions of interventional pain procedures are performed each year in the United States. Interventional pain physicians commonly administer radiocontrast media (RCM) under fluoroscopy for these procedures. However, RCM can cause various types of hypersensitivity or allergic type reactions, in an acute or delayed fashion. Furthermore, some patients report a prior history of hypersensitivity reactions to RCM when presenting to the interventional pain clinic. Both scenarios present challenges to the interventional pain physician. Objective: To describe the various types of hypersensitivity reactions to RCM, as well as strategies to prevent and manage these reactions, within the context of interventional pain practice. Method: A review of the literature from 1975 through 2011 regarding allergic type reactions to RCM, as well as iodine, and shellfish allergy, was undertaken in an effort to review and develop recommendations on managing these patients presenting to the interventional pain clinic. Keywords used in the literature search were: radiocontrast media, contrast allergy, contrast reaction, iodine allergy, shellfish allergy, and fluoroscopy. The included articles were concerned with the basic or clinical science of contrast allergy, including the physiology, epidemiology, diagnosis, and management of such reactions. Meta-analysis, review articles, and case reports addressing contrast media reactions were also included. Articles which discussed contrast media reactions in a peripheral fashion were excluded. Results: In reviewing the literature, it is apparent that the mechanisms and pathophysiology of RCM hypersensitivity reactions are still being characterized, which should soon lead to improved screenings, as well as prevention and treatment strategies. Many common themes are described throughout the literature regarding patient risk factors, testing, prevention, diagnosis, and treatment of RCM allergic-type reactions. Limitations: The current review did not perform a meta-analysis of the available data, as most of the available articles were trials that were randomly controlled. Therefore, the conclusions of the present article are general, and qualitative in nature. Conclusion: Although the mechanisms of various RCM allergic-type reactions are not entirely understood, the interventional pain physician should have a basic understanding of patient risk factors, prevention, diagnosis, and treatment of these reactions. The current review allowed for prevention and treatment strategies for managing patients with RCM hypersensitivity reactions. Key words: Radiocontrast media, contrast allergy, contrast reaction, iodine allergy, shellfish, allergy, fluoroscopy, interventional spine practice

Clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media

“…The present study suggests such events occur at a rate of 1:10,000 injections, which is lower than previously reported. 11 Therefore, severe ICM allergy should be regarded as a rare entity, 16 in line with a previous report that death is an uncommon outcome. 17 This point should be a pivotal argument when considering the postponing of well-indicated imaging or procedures due to suspected allergy.…”

“…9 The rate of bona fide allergic reactions to ICM has been reported to be in the range of 0.3e3%, 7,10 whereas severe reactions occur in 0.03e1.6% of injections. 11 Previous studies reported an exceedingly low number of allergic events. 7,8 Of note, the total number of allergic reactions varies among different studies, due to the fact that not all cutaneous manifestations are regarded universally as allergic.…”

German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome

“…Die Prävalenz allergoider Reaktionen wird auf 0,05-0,1 % nach intravenöser Gabe von iodhaltigem Kontrastmittel geschätzt und ist für nichtionische Kontrastmittel, wie sie heute in der Regel benutzt werden, mit 0,03-3 % noch einmal geringer [76][77][78][79]. Die Risikofaktoren für eine Überempfindlichkeit gegenüber iodhaltigem Kontrastmittel sind nicht vollständig geklärt [78].…”

“…The incidence of allergic reactions is estimated to be 0.05-0.1 % after intravenous administration of iodinated contrast agents and is even lower (0.03-3 %) for non-ionizing contrast agents as normally used today [76][77][78][79]. The risk factors for hypersensitivity to iodinated contrast agent are not fully understood [78].…”

Salvaging low contrast abdominal CT studies using noise-optimised virtual monoenergetic image reconstruction

“…6,7 In addition, medical conditions that require a reduction of contrast media such as renal impairment or allergy to iodine contrast media are commonly encountered in clinical practice and are associated with insufficient contrast. 8–10 …”