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Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study

Authors
 Hye Jung Park  ;  Jung-Won Park  ;  Min-Suk Yang  ;  Mi-Yeong Kim  ;  Sae-Hoon Kim  ;  Gwang Cheon Jang  ;  Young-Hee Nam  ;  Gun-Woo Kim  ;  Sujeong Kim  ;  Hye-Kyung Park  ;  Jae-Woo Jung  ;  Jong-Sook Park  ;  Hye-Ryun Kang 
Citation
 European Radiology, Vol.27(7) : 2886-2893, 2017 
Journal Title
 European Radiology 
ISSN
 0938-7994 
Issue Date
2017
MeSH
Blood Pressure/physiology* ; Cohort Studies ; Contrast Media/administration & dosage ; Contrast Media/adverse effects ; Contrast Media/chemistry ; Dose-Response Relationship, Drug ; Female ; Humans ; Hypertension/chemically induced* ; Hypertension/physiopathology ; Iohexol/administration & dosage ; Iohexol/adverse effects* ; Iohexol/analogs & derivatives* ; Iohexol/chemistry ; Male ; Middle Aged ; Osmolar Concentration ; Recurrence ; Retrospective Studies ; Risk Factors ; Severity of Illness Index
Keywords
Contrast media ; Drug hypersensitivity ; Hypersensitivity, Immediate ; Premedication ; Secondary prevention
Abstract
OBJECTIVES: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). METHODS: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. RESULTS: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. CONCLUSION: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. KEY POINTS: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.
Full Text
https://link.springer.com/article/10.1007%2Fs00330-016-4682-y
DOI
10.1007/s00330-016-4682-y
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
박중원(Park, Jung Won) ORCID logo https://orcid.org/0000-0003-0249-8749
박혜정(Park, Hye Jung) ORCID logo https://orcid.org/0000-0002-1862-1003
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165797
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