Allergic reactions to gadodiamide following interventional spinal procedures: a report of 4 cases

Gadodiamide is currently considered a safe alternative for use in interventional spinal procedures in persons with a documented allergic response to iodine-based contrast dyes and with adequate renal function. The most common reactions to gadodiamide are nausea, emesis, and headache. These reactions usually are self-limited and are reported to occur in less than 1% of patients. We report the cases of 4 patients who developed an allergic reaction to gadodiamide, 3 of whom presented within the same week, after minimally invasive interventional spinal procedures at an outpatient private practice facility. Furthermore, 3 of the 4 patients had previously been exposed to gadodiamide during prior interventional spinal procedures without reaction, and the fourth patient had a reaction on the first exposure. The clinical presentation was manifested as a rash in 3 of the 4 patients, whereas the fourth patient experienced fevers and rigors along with rash. Because the injections of gadodiamide were not administered in succession, different vials of gadodiamide were used in each patient, and the injections were given by different clinicians at different spinal levels, we hypothesize that these patients experienced an allergic reaction, rather than contamination of the gadodiamide solution. These cases may call into question the safety of gadodiamide as an alternative contrast agent.