Allergies to Iodinated Contrast Do Not Predict Adverse Reactions with Contrast Use in Genito-Urinary Surgery

Area of Science:

• Urology
• Nephrology
• Radiology
• Anesthesiology

Background:

• Iodinated contrast media (ICM) enhances imaging but can cause severe allergic reactions (SARs).
• Previous allergies to contrast media or shellfish are not reliable predictors of ICM reactions.
• The predictive value of prior allergies and the efficacy of preoperative allergic prophylaxis (PAP) for ICM used in urinary tract procedures are unclear.

Purpose of the Study:

• To evaluate if prior allergy to ICM (a-ICM) or PAP can predict SARs in patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL).

Main Methods:

• Retrospective study of 12,020 patients undergoing URS or PCNL over 22 years.
• Patients with a-ICM were analyzed based on PAP status and procedure type.
• Primary outcomes included postoperative ICU admission and intraoperative epinephrine use as surrogates for SARs.

Main Results:

• A low SAR rate of 0.5% was observed across all procedures.
• No significant difference in SAR rates was found between patients with and without a-ICM (0.4% vs. 0.5%, p=1.00).
• Logistic regression revealed no significant correlation between SARs and a-ICM or PAP. Higher American Society of Anesthesiologists score, female sex, and longer hospitalization correlated with SARs.

Conclusions:

• Severe adverse reactions to ICM during URS or PCNL are infrequent.
• Prior contrast allergies do not predict SARs.
• Preoperative allergic prophylaxis does not routinely prevent SARs in this patient cohort.