title: Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hye Jung
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
authors.forename: Min-Suk
authors.initials: MS
authors.lastname: Yang
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Mi-Yeong
authors.initials: MY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sae-Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Korea.
authors.forename: Gwang Cheon
authors.initials: GC
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Young-Hee
authors.initials: YH
authors.lastname: Nam
authors.affiliation: Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea.
authors.forename: Gun-Woo
authors.initials: GW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Sujeong
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hye-Kyung
authors.initials: HK
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Jung
authors.affiliation: Soonchunhyang University Bucheon Hospital, Bucheon, 420-767, Korea.
authors.forename: Jong-Sook
authors.initials: JS
authors.lastname: Park
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. helenmed@snu.ac.kr.
authors.forename: Hye-Ryun
authors.initials: HR
authors.lastname: Kang
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D007472:Iohexol / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; C093233:iobitridol; D007472:Iohexol
keywords: Contrast media; Drug hypersensitivity; Hypersensitivity, Immediate; Premedication; Secondary prevention