Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media.
The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported.
Unidad de Alergia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
A
A
Rosado Ingelmo
Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Málaga, Spain.
I
I
Doña Diaz
Department of Allergy, Hospital La Paz, Health Research Institute (IdiPAZ), Madrid, Spain.
R
R
Cabañas Moreno
Sección de Alergia CH Torrecárdenas, Almería, Spain.
M C
MC
Moya Quesada
Unidad de Alergia, Hospital Moncloa, Madrid, Spain.
C
C
García-Avilés
Servicio de Alergología, Hospital Quirón Málaga, Málaga, Spain.
I
I
García Nuñez
Servicio de Alergología, Hospital Universitario Ntra Sra de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain.
J I
JI
Martínez Tadeo
Servicio de Alergología, Hospital Universitario 12 de Octubre, Madrid, Spain.
R
R
Mielgo Ballesteros
Servicio de Alergia, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain.
N
N
Ortega-Rodríguez
Servicio de Alergologia, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
M A
MA
Padial Vilchez
Servicio de Alergologia, Hospital Clínico San Carlos, Madrid, Spain.
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L
Sánchez-Morillas
Unidad de Alergia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
C
C
Vila Albelda
Servicio de Alergología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
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E
Moreno Rodilla
Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Málaga, Spain.
M J
MJ
Torres Jaén
D000465:Algorithms; D003287:Contrast Media / Q000009:adverse effects*; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D012882:Skin Tests
D003287:Contrast Media
Allergy; Anaphylaxis; Contrast media; Gadolinium; Hypersensitivity; Immediate reactions; Iodinated; Nonimmediate reactions