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Premedication of patients for prior urticarial reaction to iodinated contrast medium

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Abstract

Purpose

The purpose of this study was to determine whether premedication of patients with a history of urticaria after low osmolality contrast media (LOCM) results in fewer subsequent reactions, and if a benefit is seen, to determine which premedication regimen results in the fewest reactions.

Materials and methods

The subsequent contrast enhanced studies of patients who experienced urticaria after intravenous LOCM between 2002 and 2009 were reviewed to determine whether an additional reaction occurred. Patients undergoing subsequent studies received either no premedication, or premedication with diphenhydramine alone, corticosteroid alone, or corticosteroid plus diphenhydramine. Reactions occurring without premedication were termed repeat reactions and reactions occurring after premedication were termed breakthrough reactions.

Results

Fifty patients with a history of urticaria after LOCM met the inclusion criteria and underwent 133 subsequent contrast enhanced studies. Repeat reactions occurred in 7.6% (5/66) of subsequent studies in patients receiving no premedication. Breakthrough reactions occurred in 8% (2/25), 46% (12/26), and 44% (7/16) of subsequent studies in patients receiving premedication with diphenhydramine, corticosteroid, and corticosteroid plus diphenhydramine, respectively. All subsequent reactions consisted of urticaria as the most severe manifestation; no hemodynamic instability or respiratory compromise occurred. In multivariate analysis, premedication with corticosteroid was significantly associated with higher rate of breakthrough reaction relative to no premedication (OR 14.3, 95% CI: 4.1–50.4), as was premedication with corticosteroid plus diphenhydramine (OR 8.3, 95% CI: 1.8–37.9).

Conclusion

The results suggest that premedication of patients with a history of urticaria after LOCM may not be necessary.

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References

  1. Callahan MJ, Poznauskis L, Zurakowski D, Taylor GA (2009) Nonionic iodinated intravenous contrast material-related reactions: incidence in large urban children’s hospital–retrospective analysis of data in 12,494 patients. Radiology 250(3):674–681. doi:10.1148/radiol.2503071577

    Article  PubMed  Google Scholar 

  2. Hunt CH, Hartman RP, Hesley GK (2009) Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: retrospective review of 456,930 doses. AJR Am J Roentgenol 193(4):1124–1127. doi:10.2214/ajr.09.2520

    Article  PubMed  Google Scholar 

  3. Wang CL, Cohan RH, Ellis JH, et al. (2008) Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. AJR Am J Roentgenol 191(2):409–415. doi:10.2214/ajr.07.3421

    Article  PubMed  Google Scholar 

  4. Mortele KJ, Oliva MR, Ondategui S, Ros PR, Silverman SG (2005) Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital. AJR Am J Roentgenol 184(1):31–34

    Article  PubMed  Google Scholar 

  5. Cochran ST (2005) Anaphylactoid reactions to radiocontrast media. Curr Allergy Asthma Rep 5(1):28–31

    Article  CAS  PubMed  Google Scholar 

  6. Katayama H, Yamaguchi K, Kozuka T, et al. (1990) Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 175(3):621–628

    CAS  PubMed  Google Scholar 

  7. Lasser EC, Berry CC, Talner LB, et al. (1987) Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material. N Engl J Med 317(14):845–849. doi:10.1056/nejm198710013171401

    Article  CAS  PubMed  Google Scholar 

  8. Lasser EC, Berry CC, Mishkin MM, et al. (1994) Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. AJR Am J Roentgenol 162(3):523–526

    Article  CAS  PubMed  Google Scholar 

  9. Greenberger PA (1984) Contrast media reactions. J Allergy Clin Immunol 74(4 Pt 2):600–605

    Article  CAS  PubMed  Google Scholar 

  10. Davenport MS, Cohan RH, Caoili EM, Ellis JH (2009) Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology 253(2):372–379. doi:10.1148/radiol.2532090465

    Article  PubMed  Google Scholar 

  11. Freed KS, Leder RA, Alexander C, DeLong DM, Kliewer MA (2001) Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. AJR Am J Roentgenol 176(6):1389–1392

    Article  CAS  PubMed  Google Scholar 

  12. Morcos SK (2005) Review article: acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol 78(932):686–693. doi:10.1259/bjr/26301414

    Article  CAS  PubMed  Google Scholar 

  13. Greenberger PA, Patterson R, Radin RC (1984) Two pretreatment regimens for high-risk patients receiving radiographic contrast media. J Allergy Clin Immunol 74(4 Pt 1):540–543

    Article  CAS  PubMed  Google Scholar 

  14. Greenberger PA, Halwig JM, Patterson R, Wallemark CB (1986) Emergency administration of radiocontrast media in high-risk patients. J Allergy Clin Immunol 77(4):630–634

    Article  CAS  PubMed  Google Scholar 

  15. ACR Manual on Contrast Media. (2013). http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2013_Contrast_Media.pdf. Accessed 10/10/2013 2013

  16. Ring J, Simon RA, Arroyave CM (1978) Increased in vitro histamine release by radiographic contrast media in patients with history of incompatibility. Clin Exp Immunol 34(2):302–309

    CAS  PubMed Central  PubMed  Google Scholar 

  17. Kelly JF, Patterson R, Lieberman P, Mathison DA, Stevenson DD (1978) Radiographic contrast media studies in high-risk patients. J Allergy Clin Immunol 62(3):181–184

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Amy B. Kolbe, Robert P. Hartman, Christopher H. Hunt & Gina K. Hesley

  2. Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Tanya L. Hoskin & Rickey E. Carter

  3. Department of Allergic Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Daniel E. Maddox

Authors
  1. Amy B. Kolbe
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  2. Robert P. Hartman
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  3. Tanya L. Hoskin
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  4. Rickey E. Carter
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  5. Daniel E. Maddox
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  6. Christopher H. Hunt
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  7. Gina K. Hesley
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Corresponding author

Correspondence to Amy B. Kolbe.

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Kolbe, A.B., Hartman, R.P., Hoskin, T.L. et al. Premedication of patients for prior urticarial reaction to iodinated contrast medium. Abdom Imaging 39, 432–437 (2014). https://doi.org/10.1007/s00261-013-0058-9

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  • DOI: https://doi.org/10.1007/s00261-013-0058-9

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