Changes in Risk of Immediate Adverse Reactions to Iodinated Contrast Media by Repeated Administrations in Patients with Hepatocellular Carcinoma

Abstract

BackgroundTo elucidate whether repeated exposures to iodinated contrast media increase the risk of adverse reaction.Materials and MethodsWe retrospectively reviewed 1,861 patients with hepatocellular carcinoma who visited authors’ institution, a tertiary referral center, between 2004 and 2008. We analyzed cumulative probability of adverse reactions and risk factors. We categorized all symptoms into hypersensitivity reactions, physiologic reactions, and other reactions, according to the American College of Radiology guidelines, and evaluated each category as an event. We estimated the association between hazard for adverse reactions and the number of cumulative exposures to contrast media. We also evaluated subsequent contrast media injections and adverse reactions.ResultsThere were 23,684 contrast media injections in 1,729 patients. One hundred and thirty-two patients were excluded because they were given no contrast media during the study period. Adverse reactions occurred in 196 (0.83%) patients. The cumulative incidence at 10th, 20th, and 30th examination was 7.9%, 15.2%, and 24.1%, respectively. Presence of renal impairment was found to be one of risk factors for adverse reactions. The estimated hazard of overall adverse reaction gradually decreased until around 10th exposure and rose with subsequent exposures. The estimated hazard of hypersensitivity showed V-shaped change with cumulative number of exposures. The estimated hazard of physiologic reaction had a tendency toward decreasing and that of other reaction had a tendency toward increasing. Second adverse reaction was more severe than the initial in only one among 130 patients receiving subsequent injections.ConclusionRepeated exposures to iodinated contrast media increase the risk of adverse reaction.

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

“…Few studies describing the cumulative effect of repeated exposures to LOCM on drug hypersensitivity have been undertaken. Repeated exposures increased the risk of adverse reactions in patients with hepatocellular carcinoma [39], although in a nested casecontrol study, the number of exposures to LOCM was lower in patients with hypersensitivity than in controls [4]. The increased incidence of HSR with repeated exposure may be the result of IgE-mediated sensitization.…”

Premedication for Iodinated Contrast Media Induced Immediate Hypersensitivity Reactions

“…Risk factors for ICM-induced iHR include asthma [25], especially if uncontrolled, a previous severe reaction [21], and multiple exposures [26], female sex, and drug allergies [21]. Park et al observed age, diabetes, chronic urticaria, and allergy to drugs other than ICM as risk factors [27•].…”

Anaphylactoid Reactions to the Nonvascular Administration of Water-Soluble Iodinated Contrast Media

“…Please see the ACR manual on contrast media [1] for free online access to the ACR treatment guidelines, and Bang et al [59] for an excellent foldable pocket-, wallet-, or purse-sized summary. This may become more critical in the future because there are now reports that the incidence of anaphylactoidlike reactions may increase with serial iodinated contrast media exposure [60]. Severe and life-threatening reactions can occur with the nonvascular administration of iodinated contrast media because some iodinated contrast media are absorbed from any body surface and cavity.…”