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Hypersensitivity Reactions to Gadolinium-Based Contrast Agents: Update From an Allergist's Point of View
Francesca Losa1, Giovanni Paoletti2,3, Giulia Costanzo4
1SC Allergologia, Reumatologia e Immunologia Clinica, Mantova, Itlay.
Clinical and Translational Allergy
|July 29, 2025
Summary
Gadolinium-based contrast agents (GBCAs) can cause hypersensitivity reactions (HSRs). Allergological evaluation, including skin testing, is crucial for diagnosing and managing these adverse events, enabling safe re-exposure.
Area of Science:
- Radiology
- Allergology
- Pharmacovigilance
Background:
- Increased use of Magnetic Resonance Imaging (MRI) correlates with more reported adverse events (AEs) from gadolinium-based contrast agents (GBCAs).
- Adverse events are classified as predictable Type A or unpredictable Type B hypersensitivity reactions (HSRs).
Purpose of the Study:
- To review hypersensitivity reactions (HSRs) to gadolinium-based contrast agents (GBCAs).
- To focus on diagnostic and management strategies for GBCAs-related HSRs from an allergological viewpoint.
Main Methods:
- Literature review of recent studies on GBCAs-related HSRs.
- Analysis of classification, clinical presentation, and pathophysiological mechanisms.
- Evaluation of current diagnostic, risk stratification, and prevention recommendations.
Main Results:
- Type B reactions, including allergic and non-allergic HSRs, present significant diagnostic and therapeutic challenges.
- HSRs to GBCAs are rare but necessitate thorough evaluation and individualized management.
Conclusions:
- Allergological work-up, incorporating skin testing and graded challenges, is vital for safe re-exposure in patients with a history of GBCAs reactions.
- Careful evaluation and tailored management are essential for patients experiencing HSRs to GBCAs.
Keywords:
cross‐reactivity (CR)drug provocation tests (DPT)gadolinium‐based contrast agents (GBCAs)hypersensitivity reactions (HSRs)premedicationskin test (ST)More Related Videos
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