Validation of Practical Pathway in Patients With Anaphylaxis to Low Osmolar Contrast Media: A Retrospective Cohort Study

Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement from the American College of Radiology and the American Academy of Allergy, Asthma & Immunology

Intravenous iodinated contrast media (ICM) is widely used in the United States, and it is imperative to provide guidance on the management of adverse reactions to ICM as well as the preparation, planning, and potential premedication for patients with previous reactions. Currently there is a discordance between the American College of Radiology Contrast Manual, which recommends premedication to prevent repeat hypersensitivity reactions to ICM, and the Anaphylaxis 2020 Practice Parameters Update, which recommends against routine administration of glucocorticoids and/or antihistamines to prevent anaphylaxis with prior ICM hypersensitivity reactions. A task force of experts from radiology who are also members of the American College of Radiology Committee on Drugs and Contrast Media and expert allergists/immunologists including members of the Adverse Reactions to Drugs, Biologics and Latex Committee of American Academy of Allergy, Asthma & Immunology evaluated the scientific evidence to develop consensus recommendations that are endorsed by both organizations. The task force took into account the strength of evidence and balanced the potential risks of recurrent reactions with those of premedication and product avoidance when making these recommendations to improve and standardize the care of patients who experience or have a history of reaction to ICM. © Radiological Society of North America and American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc on behalf of American Academy of Allergy, Asthma & Immunology and by Radiological Society of North America. All rights are reserved, including those for text and data mining, AI training, and similar technologies. This paper was jointly developed by The Journal of Allergy and Clinical Immunology: In Practice, Radiology and jointly published by Elsevier Inc and Radiological Society of North America. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. Keywords: Contrast allergy, Contrast hypersensitivity, Iodinated contrast allergy, Iodinated contrast hypersensitivity, Anaphylaxis, Contrast skin testing, Contrast switching, Contrast reaction, Delayed contrast reaction, Immediate contrast reaction.

Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement From the American College of Radiology and the AAAAI

Intravenous iodinated contrast media (ICM) is widely used in the United States, and it is imperative to provide guidance on the management of adverse reactions to ICM as well as the preparation, planning, and potential premedication for patients with previous reactions. Currently there is a discordance between the American College of Radiology Contrast Manual, which recommends premedication to prevent repeat hypersensitivity reactions to ICM, and the Anaphylaxis 2020 Practice Parameters Update, which recommends against routine administration of glucocorticoids and/or antihistamines to prevent anaphylaxis with prior ICM hypersensitivity reactions. A task force of experts from radiology who are also members of the American College of Radiology Committee on Drugs and Contrast Media and expert allergists/immunologists including members of the Adverse Reactions to Drugs, Biologics and Latex Committee of American Academy of Allergy, Asthma & Immunology evaluated the scientific evidence to develop consensus recommendations that are endorsed by both organizations. The task force took into account the strength of evidence and balanced the potential risks of recurrent reactions with those of premedication and product avoidance when making these recommendations to improve and standardize the care of patients who experience or have a history of reaction to ICM.

CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity

Contrast media, including iodinated contrast media and gadolinium-based contrast agents, are commonly administered pharmaceuticals with excellent safety profiles. However, a minority of the population may experience a hypersensitivity reaction following intravenous administration. Hypersensitivity reactions can be immediate or delayed, and range from mild, such as urticaria, to severe, including anaphylaxis. There is emerging evidence that longstanding pretreatment protocols, such as diphenhydramine and corticosteroids, are ineffective and have the potential for side effects and other harms. Moreover, the evidence for efficacy on which this practice is based is weak and outdated. A joint collaborative working group of representatives from the Canadian Association of Radiologists and the Canadian Society of Allergy and Clinical Immunology was assembled to inform medical professionals and hospital policies regarding hypersensitivity reactions to contrast media. The objectives of the working group were to provide an overview of the epidemiology, physiology, risk factors, and types of hypersensitivity reactions; to synthesize the evidence for pretreatment strategies that minimize the risk of a breakthrough reaction for both iodinated contrast media and gadolinium-based contrast agents; to review the allergy investigations used to evaluate patients with a history of severe hypersensitivity reaction; and to provide an overview of existing guidelines. Following appraisal of the evidence, the working group established recommendations based on consensus in this practice guidance.

Drug provocation tests (DPTs) of contrast media: Useful or not useful? - A narrative review

Drug provocation tests (DPTs) are also used in some patients with a history of a contrast medium (CM)-hypersensitivity reaction. Since the use of contrast agents requires special knowledge that is present in radiology but not necessarily in allergology, this overview should close the knowledge gaps. The literature, and the package inserts of the industry dealing with DPTs in contrast hypersensitivity reactions was analyzed and the results presented. Historical analyses revealed that provocation tests were already done in the past, and called pre-testing. Due to disadvantages, this diagnostic tool was abandoned. A few years later, DPT was introduced as an innovative diagnostic procedure. The DPT has the 3 main disadvantages: a missing standardization, patients at risk (such as compromised renal function) are rarely taken into account, and a negative DPT does not exclude a subsequent CM reaction. DPTs (formerly called pre-testing) are a well-known method for diagnosing CM-related hypersensitivity reactions. Since the disadvantages of this diagnosis outweigh the advantages, we propose replacing DPT with routine contrast-enhanced imaging examination in radiology.