Acute Adverse Reactions to Nonionic Iodinated Contrast Media

Abstract

Objectives We aimed to meta-analytically compare the incidence of acute adverse reactions (AARs) to nonionic iodinated contrast media (ICM) according to the type of ICM in patients who underwent radiologic examinations with administration of ICM via intravascular route. Materials and Methods A systematic literature search identified studies evaluating the incidence of AARs to 7 nonionic ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, ioversol, and iodixanol) with extractable outcomes. These outcomes were pooled using a random-effects model, and the effect of ICM type on the incidence of overall and severe AARs was evaluated using meta-regression analysis. Results Thirty studies with 1,360,488 exposures to ICM were included. The pooled incidences of overall and severe AARs to nonionic ICM were 1.03% (95% confidence interval [CI], 0.81%–1.30%; I 2 = 0.99) and 0.0141% (95% CI, 0.0108%–0.0183%; I 2 = 0.56), respectively. Iomeprol had the highest overall AAR incidence (1.74%; 95% CI, 0.79%–3.76%; I 2 = 0.99), followed by iohexol (1.21%; 95% CI, 0.67%–2.17%; I 2 = 0.99), iopamidol (1.10%; 95% CI, 0.60%–2.03%; I 2 = 0.99), ioversol (0.88%; 95% CI, 0.43%–1.83%; I 2 = 0.96), iodixanol (0.85%; 95% CI, 0.36%–1.95%; I 2 = 0.99), iopromide (0.82%; 95% CI, 0.43%–1.55%; I 2 = 0.99), and iobitridol (0.77%; 95% CI, 0.36%–1.62%; I 2 = 0.99). Multivariable meta-regression analysis revealed that study design (P = 0.0014) and premedication (P = 0.0230) were statistically significant determinants affecting the incidence of overall AARs. Iodinated contrast media type did not affect the incidence of overall and severe AARs (P = 0.1453 and 0.4265, each). Conclusions The varying pooled incidences of overall and severe AARs to specific types of nonionic ICM do not remain as significant after adjusting confounders. Our results may support nonrestriction of certain types of nonionic ICM in the context of AAR avoidance.

Premedication for Iodinated Contrast Media Induced Immediate Hypersensitivity Reactions

“…The high-osmolar ionic monomers (HOCM) amidotrizoate and ioxithalamate and low-osmolar ionic dimer (LOCM-ionic) ioxaglate are abandoned for parenteral administrations due to a higher risk of adverse events with iHR occurring in 16-30% of non-premedicated patients [19]. In LOCM, the frequency of adverse events is around 1.03% (95% CI 0.81-1.30%) [20]…”

“…[21], with iHR in 0.6% [22] and severe reactions occurring in around 0.014% (95% CI, 0.011-0.018%) [20] of administrations. Fatality rate (for both ionic and nonionic ICM) is estimated to be in the range of 1 in 100,000 [23] to 1 in 10 million [5,21] administrations.…”

Medios de contraste intravascular en tomografía computada y resonancia magnética: lo que el clínico necesita saber

“…Las reacciones tipo alérgicas son independientes de la dosis y concentración del medio de contraste. Tienen una incidencia en general de 1,03% y en reacción grave de 0,014% (Suh et al, 2019), aumentando 5 a 6 veces su riesgo de presentar una siguiente reacción (Morcos, 2005…”

Topical Issues of Rational Use of Iodine-Containing Contrast Agents in X-Ray Diagnostics

“…Приблизительно на столько же растет число чрескожных сосудистых вмешательств [2], которые вообще невозможны без РКС. В настоящее время накопленные данные свидетельствуют о том, что группа неионных низкоосмоляльных средств, к которым относится йопромид, обладает наиболее благоприятным профилем безопасности [3,4].…”

“…Неблагоприятные побочные эффекты от введения контрастного средства варьируются от незначительных физиологических нарушений до редких, но тяжелых жизнеугрожающих реакций [4]. Поэтому детальное знание природы возникновения разнообразных побочных эффектов, их вероятности развития в связи с уже существующими состояниями больного, способов их профилактики и лечения необходимы для рационального использования РКС.…”