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CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity.

Adam Byrne1,2, D Blair Macdonald3,4, Iain D C Kirkpatrick5,6

  • 1Department of Pediatrics, Division of Infectious Disease, Immunology & Allergy, University of Ottawa, Ottawa, ON, Canada.

Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes
|January 11, 2025
PubMed
Summary

Pretreatment with diphenhydramine and corticosteroids is ineffective for preventing hypersensitivity reactions to contrast media. New guidelines recommend against these outdated protocols for iodinated contrast media and gadolinium-based contrast agents.

Keywords:
allergygadolinium-based contrast agentshypersensitivityiodinated contrast media

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Area of Science:

  • Radiology and Immunology
  • Pharmacology

Background:

  • Contrast media, including iodinated and gadolinium-based agents, are widely used but can cause hypersensitivity reactions.
  • Current pretreatment protocols for these reactions are based on weak evidence and may cause harm.

Purpose of the Study:

  • To evaluate the efficacy of current pretreatment strategies for contrast media hypersensitivity.
  • To develop evidence-based recommendations for managing hypersensitivity reactions to contrast media.

Main Methods:

  • A joint working group synthesized evidence on contrast media hypersensitivity.
  • Reviewed epidemiology, risk factors, and pretreatment efficacy for iodinated and gadolinium-based contrast agents.
  • Assessed allergy investigations and existing guidelines.

Main Results:

  • Emerging evidence suggests longstanding pretreatment protocols are ineffective and potentially harmful.
  • The efficacy of diphenhydramine and corticosteroids is not supported by strong evidence.

Conclusions:

  • Pretreatment protocols for contrast media hypersensitivity require re-evaluation.
  • Consensus-based recommendations were established to guide medical professionals and hospital policies.