Contrast Medium Hypersensitivity: A Large Italian Study with Long-Term Follow-Up

Area of Science:

• Radiology
• Allergy and Immunology

Background:

• Hypersensitivity reactions (HRs) to contrast media (CM) pose a significant clinical challenge.
• Understanding differences between iodinated contrast media (ICM) and gadolinium-based contrast media (GBCM) HRs is crucial for patient safety.

Purpose of the Study:

• To compare the characteristics of HRs to ICM versus GBCM.
• To investigate long-term outcomes including re-exposure, premedication efficacy, and new reaction development over 5 years.

Main Methods:

• Retrospective single-center study involving 350 patients with mild to moderate HRs.
• Data collected included clinical history, comorbidities, skin test (ST) results, re-exposure events, and CM used.
• Analysis compared patient demographics, comorbidities, and reaction patterns between ICM and GBCM HRs.

Main Results:

• Patients with GBCM HRs showed higher prevalence of asthma, food allergy, drug hypersensitivity, and neurologic disease.
• Patients with ICM HRs had a higher incidence of cardiovascular disease and cancer history.
• A significant delay in STs was observed in patients with negative results (66 months).
• Iomeprol, iopamidol, and gadobenic acid were frequently implicated in HRs with positive STs.
• Despite negative STs and premedication, 7.1% of patients experienced new HRs upon re-exposure to CM.

Conclusions:

• Distinct comorbidity profiles are associated with hypersensitivity reactions to ICM and GBCM.
• Skin testing may be delayed, and new hypersensitivity reactions can occur even with negative tests and preventative measures.