Iodinated Contrast Media Substitution to Prevent Recurrent                     Hypersensitivity Reactions: A Systematic Review and                     Meta-Analysis

Umakoshi, Hiroyasu; Nishizaki, Takashi; Takada, Akira; Hirasawa, Naoki; Ishihara, Shunichi; Takehara, Yasuo; Naganawa, Shinji; Davenport, Matthew S.; Terasawa, Teruhiko

doi:10.1148/radiol.220370

Cited by 15 publications

(4 citation statements)

References 29 publications

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“…Notably, corticosteroid prophylaxis has an incomplete mitigating effect on the incidence of allergic-like CM reactions in high-risk patients and does not appear to affect reaction severity [ 16 ]. As a matter of fact, it is recommended to change the CM molecule in patients with documented previous CM-induced ADRs [ 17 ]; furthermore, in patients with a previous severe ACR to CM in whom a new examination is requested [ 17 ], some scientific societies suggest that it could be appropriate to have the presence of an anesthesiologist in the CT room [ 18 ], given that “…Patients who have had a prior allergic-like reaction….to contrast medium have an approximately fivefold increased risk of developing a future allergic-like reaction if exposed to the same class of contrast medium again…” [ 19 ]. Furthermore, the heterogeneity of answers concerning the need to change the diagnostic examination after a severe ADR to CM highlights the urge for education improvement of young radiologists on this topic as advocated by most participants.…”

Section: Discussionmentioning

confidence: 99%

How young radiologists use contrast media and manage adverse reactions: an international survey

Albano,

Mallardi,

Afat

et al. 2024

Insights Imaging

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Objectives To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR). Methods A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed. Results Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25–39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient’s lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively. Conclusion Training in CM use and management ADR should be implemented in the training of radiology residents. Critical relevance statement We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions. Key points • This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

How young radiologists use contrast media and manage adverse reactions: an international survey

Albano,

Mallardi,

Afat

et al. 2024

Insights Imaging

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“…For example, patients without acute kidney injury (AKI) or an estimated glomerular filtration rate of 30 mL/min or more per 1.73 m 2 have a risk of contrast-induced AKI close to 0% . Similarly, patients who have had a prior mild hypersensitivity reaction to iodinated contrast medium are at very low risk (less than 1%) of a life-threatening reaction on repeat administration, especially using standard-of-care risk-mitigation strategies . Therefore, accepting a 30-percentage–point decrement in diagnostic accuracy in these settings likely causes harm.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who do have AKI or an estimated glomerular filtration rate less than 30 mL/min per 1.73 m 2 not receiving maintenance dialysis have a more uncertain risk of contrast-induced AKI (0% to 17%) . Patients with a prior moderate or severe hypersensitivity reaction to iodinated contrast medium have an unclear risk that is complicated to mitigate . Therefore, the risk benefit-analysis in these settings is more complicated and probably depends on the pretest suspected diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department

et al. 2023

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ImportanceIntravenous (IV) contrast medium is sometimes withheld due to risk of complication or lack of availability in patients undergoing computed tomography (CT) for abdominal pain. The risk from withholding contrast medium is understudied.ObjectiveTo determine the diagnostic accuracy of unenhanced abdominopelvic CT using contemporaneous contrast-enhanced CT as the reference standard in emergency department (ED) patients with acute abdominal pain.Design, Setting, and ParticipantsThis was an institutional review board–approved, multicenter retrospective diagnostic accuracy study of 201 consecutive adult ED patients who underwent dual-energy contrast-enhanced CT for the evaluation of acute abdominal pain from April 1, 2017, through April 22, 2017. Three blinded radiologists interpreted these scans to establish the reference standard by majority rule. IV and oral contrast media were then digitally subtracted using dual-energy techniques. Six different blinded radiologists from 3 institutions (3 specialist faculty and 3 residents) interpreted the resulting unenhanced CT examinations. Participants included a consecutive sample of ED patients with abdominal pain who underwent dual-energy CT.ExposureContrast-enhanced and virtual unenhanced CT derived from dual-energy CT.Main outcomeDiagnostic accuracy of unenhanced CT for primary (ie, principal cause[s] of pain) and actionable secondary (ie, incidental findings requiring management) diagnoses. The Gwet interrater agreement coefficient was calculated.ResultsThere were 201 included patients (female, 108; male, 93) with a mean age of 50.1 (SD, 20.9) years and mean BMI of 25.5 (SD, 5.4). Overall accuracy of unenhanced CT was 70% (faculty, 68% to 74%; residents, 69% to 70%). Faculty had higher accuracy than residents for primary diagnoses (82% vs 76%; adjusted odds ratio [OR], 1.83; 95% CI, 1.26-2.67; P = .002) but lower accuracy for actionable secondary diagnoses (87% vs 90%; OR, 0.57; 95% CI, 0.35-0.93; P &lt; .001). This was because faculty made fewer false-negative primary diagnoses (38% vs 62%; OR, 0.23; 95% CI, 0.13-0.41; P &lt; .001) but more false-positive actionable secondary diagnoses (63% vs 37%; OR, 2.11, 95% CI, 1.26-3.54; P = .01). False-negative (19%) and false-positive (14%) results were common. Interrater agreement for overall accuracy was moderate (Gwet agreement coefficient, 0.58).ConclusionUnenhanced CT was approximately 30% less accurate than contrast-enhanced CT for evaluating abdominal pain in the ED. This should be balanced with the risk of administering contrast material to patients with risk factors for kidney injury or hypersensitivity reaction.

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“…For the whole population, several prophylactic approaches have also been reported, such as lower dose and injection speed, extrinsic warming of ICM to 37℃, and stratified dietary preparation regimen [15][16][17][18]. However, there is a lack of solid high-quality evidence of their effectiveness [19][20][21]. Up to now, the efficacy of comprehensive prevention strategies involving the optimal management of ICM-AAR risk factors in the whole population has not been systematically evaluated.…”

Section: Introductionmentioning

confidence: 99%

Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital

Liu

Qiu

Liu

et al. 2023

Med Biol Eng Comput

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For contrast-enhanced CT examinations, there is a lack of comprehensive optimal management strategies of risk factors to reduce the risk of iodinated contrast media (ICM)–induced acute adverse reactions (AAR). Here, we determine the relationship between the rate of ICM-AAR and a stratified assessment and warning (SAW) regimen, which integrated risk identification, stratification, early warning, and prevention. A total of 120,822 cases in the conventional assessment period (58 years ± 15, 55.25% men) and 150,343 cases (58 years ± 14, 55.83% men) in the SAW period were enrolled. The results showed that the total AAR incidence in the SAW period (414/150,343, 0.28%) was lower than that in the conventional assessment period (506/120,822, 0.42%, P < 0.001), in which the proportion of AAR patients decreased by one-third. It mainly presented as decreases in mild and moderate reactions (P < 0.001), and a decrease in the proportion of moderate AAR patients (P = 0.001). Subgroup analysis showed lower mild and moderate AAR incidence in patients with different risk levels and with different ICM injection parameters following SAW regimen. We concluded that SAW regimen was associated with lower incidence of mild and moderate AAR, and decreased proportion of moderate AAR patients, which held potential for improved ICM safety. Graphical abstract

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Iodinated Contrast Media Substitution to Prevent Recurrent Hypersensitivity Reactions: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 29 publications

How young radiologists use contrast media and manage adverse reactions: an international survey

How young radiologists use contrast media and manage adverse reactions: an international survey

Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department

Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital

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