How to Manage Allergic Reactions to Contrast Agent in Pregnant Patients

Sikka, Amrita; Bisla, Jaspreet K.; Rajan, Priya; Chalifoux, Laurie A.; Goodhartz, Lori A.; Miller, Frank H.; Yaghmai, Vahid; Horowitz, Jeanne M.

doi:10.2214/ajr.15.14976

Cited by 11 publications

(4 citation statements)

References 21 publications

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“…The use of steroids prior to contrast media administration to mitigate allergy due to contrast media had been documented [20]. Methylprednisolone, dexamethasone or adrenaline administration 2 hrs prior to the administration of contrast media has been recommended [21,22,23]. The control group had a relatively normal histological feature of renal tubules with obvious vacuole and epithelial cells.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of dexamethasone and methylprednisolone administration on visceral organs prior to contrast radiography in Nigerian indigenous breed of dogs

Kalang¹,

Bata²,

Malam³

et al. 2022

GSC Biol. Pharm. Sci.

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The number of medical procedures using iodinated contrast media has increased in recent decades, though contrast media are regarded as safer. Nine Nigerian indigenous breed of dogs were acquired and housed in the Small Animal Kennel of the Nigerian Veterinary Research Institute Veterinary Hospital. The nine dogs were grouped into three groups of three animals each. Group A was the control, and were given urografin at 370 mg/kg, ten minutes before exposure to x-ray. Group B were given dexamethasone at 1 mg/kg 2 hours before x-ray and urografin ten minutes before exposure to x-ray. Group C were given methylprednisolone at 1 mg/kg 2 hours before exposure to x-ray, and urografin ten minutes before exposure to x-ray. All groups were given urografin 24 hours later at 370 mg/kg. Pathological changes in the liver and the kidney were more severe in the methylprednisolone treated group, followed by dexamethasone treated group. While, the dexamethasone treated group recorded more pathologies in the spleen. The use of anti-inflammatory drugs (dexamethasone and methylprednisolone) tends to be more protective in the heart. We recommend that the use of steroids such as dexamethasone and methylprednisolone be avoided in contrast radiography except where heart pathology exist

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Section: Discussionmentioning

confidence: 99%

Evaluation of dexamethasone and methylprednisolone administration on visceral organs prior to contrast radiography in Nigerian indigenous breed of dogs

Kalang¹,

Bata²,

Malam³

et al. 2022

GSC Biol. Pharm. Sci.

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“…Understanding the effects of GBCAs depends greatly on understanding the primary clinical recommendations for their use, the dangers for the mother and the foetus, and the side effects. It is crucial to understand that allergic and non-allergic reactions, such as nausea and vomiting, account for most shortterm dangers [13]. However, severe reactions that are typical in pregnancy include premature labour, repeated late decelerations of the foetal heart rate, and protracted foetal bradycardia [7].…”

Section: Short and Long-term Effectsmentioning

confidence: 99%

Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety

Alghamdi¹

2023

Cureus

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Gadolinium-based contrast agents (GBCAs) are commonly used in magnetic resonance imaging (MRI) to enhance the visualisation and characterisation of the region of interest/lesion. Internal structures are well seen with MRI with good spatial resolution. Although MRI is generally considered safe during pregnancy, concerns have been raised regarding the safety of GBCAs, particularly during the first trimester. Limited studies have been conducted to assess the safety of GBCAs in pregnant women, with conflicting results.A comprehensive literature search was conducted using PubMed, SpringerLink, Medscape, ResearchGate and Wiley Online Library. The search terms included various combinations of MRI, pregnancy, first trimester, gadolinium contrast agents, foetus, risk, and toxicity. The search criteria were articles published in English in the last 20 years and indexed in the MEDLINE or Embase databases.The majority of studies found no definitive evidence that GBCAs are harmful during pregnancy, particularly during the first trimester. Some studies reported no increased risk of adverse outcomes in infants exposed to GBCAs during the first trimester. However, other studies showed inconsistent results. Retrospective cohort studies provided some reassurance regarding the safety of GBCAs when indicated in pregnant women but did not address potential long-term adverse outcomes in infants exposed to GBCAs during gestation. The literature review also highlights the importance of further evaluating the subacute and chronic effects of GBCA exposure in infants.The safety of GBCAs during pregnancy, particularly during the first trimester, remains uncertain. More large-scale, long-term studies are needed to clarify the safety of GBCAs in pregnant women and their potential effects on foetal and neonatal outcomes. Until conclusive evidence is available, healthcare providers should carefully weigh the benefits and risks of using GBCAs during pregnancy and consider alternative imaging modalities, such as non-contrast MRI or ultrasound, when necessary.

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“…The manual uterus displacement makes it easier to preform chest compression in cases of severe reactions that require cardiovascular support. 46 Corticosteroids (FDA category B) and diphenhydramine (FDA category C) are recommended for prophylaxis with patients who are at risk for allergic reactions to contrast media. 4,39 For corticosteroids, prednisone and dexamethasone in particular are recommended as premedication as they are mobilized in the placenta and will not reach fetal circulation.…”

Section: Management Of Contrast Reactions In Pregnancymentioning

confidence: 99%

“…The manual uterus displacement makes it easier to preform chest compression in cases of severe reactions that require cardiovascular support. 46…”

Section: Introductionmentioning

confidence: 99%

Emergency Imaging in Pregnancy and Lactation

et al. 2020

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The use of diagnostic imaging studies in the emergency setting has increased dramatically over the past couple of decades. The emergency imaging of pregnant and lactating patients poses unique challenges and calls upon the crucial role of radiologists as consultants to the referring physician to guide appropriate use of imaging tests, minimize risk, ensure timely management, and occasionally alleviate unwarranted trepidation. A clear understanding of the risks and benefits involved with various imaging tests in this patient population is vital to achieve this. This review discusses the different safety and appropriateness issues that could arise with the use of ionizing radiation, iodinated-, and gadolinium-based contrast media and radiopharmaceuticals in pregnant and lactating patients. Special considerations such as trauma imaging, safety concerns with magnetic resonance imaging and ultrasound, management of claustrophobia, contrast extravasation, and allergic reactions are also reviewed. The consent process for these examinations has also been described.

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How to Manage Allergic Reactions to Contrast Agent in Pregnant Patients

Abstract: Adequate preparation and a team approach will provide optimal care for a pregnant patient who has an allergic reaction to a contrast agent.

Cited by 11 publications

References 21 publications

Evaluation of dexamethasone and methylprednisolone administration on visceral organs prior to contrast radiography in Nigerian indigenous breed of dogs

Evaluation of dexamethasone and methylprednisolone administration on visceral organs prior to contrast radiography in Nigerian indigenous breed of dogs

Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety

Emergency Imaging in Pregnancy and Lactation

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