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

• DOI: 10.1007/s00330-016-4682-y
• Publication Date: 2016-12-14T16:46:18Z
• 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
• Keywords: Male; Immediate; Iohexol/administration & dosage; Blood Pressure/physiology*; Premedication; Iohexol; 610; Contrast Media; Blood Pressure; Severity of Illness Index; Dose-Response Relationship; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Recurrence; Risk Factors; Iohexol/analogs & derivatives*; Hypersensitivity; Humans; Contrast Media/adverse effects; Contrast Media/administration & dosage; Iohexol/adverse effects*; Retrospective Studies; Hypertension/physiopathology; Dose-Response Relationship, Drug; Contrast media; Secondary prevention; Hypertension/chemically induced*; Osmolar Concentration; Contrast Media/chemistry; Middle Aged; 3. Good health; Iohexol/chemistry; Hypertension; Female; Drug; Drug hypersensitivity

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).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.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.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.• 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.