Pharmacological Prevention of Hypersensitivity Reactions Caused by Iodinated Contrast Media: A Systematic Review and Meta-Analysis

Abstract

Objectives: Hypersensitivity reactions (HSRs) are uncommon but serious adverse events following the administration of iodinated contrast media (ICM) prior to CT imaging. While premedication is almost universally given in high-risk patients, there is a lack of evidence regarding the efficacy of such premedication. This study aims to determine the efficacy of premedication with corticosteroids prior to ICM administration in the prevention of HSRs through meta-analysis. Materials and Methods: An extensive review of the literature yielded 404 potentially relevant studies. Of these, five studies met the inclusion criteria of this meta-analysis. Pooled HSR event rates were obtained from each of the studies for both patients who had and who had not received premedication with corticosteroids. Heterogeneity between studies was also determined. Results: A total of 736 patients across all five studies were included in the analysis. Patients who did not receive premedication had initial pooled HSR rates of 0.16 (95% CI, 0.07–0.35) across all studies. Following premedication, pooled HSR rates dropped to 0.02 (95% CI, 0.01–0.06). Patients who had prior HSRs were significantly less likely to experience HSRs (OR = 0.09; 95% CI, 0.03–0.25; p < 0.00001) after treatment with premedication. Conclusions: This meta-analysis offers evidence for the reduction in the recurrence of moderate and severe HSRs in patients who have a history of such reactions. Premedication with corticosteroids prior to ICM administration is thus highly recommended in high-risk patients.

The Effect of Iodinated Contrast Media Sensitivity on the Prognosis of Patients with STEMI

“…Premedication to mitigate possible HSR for known susceptible patients with ICM sensitivity includes antihistamines and corticosteroids can be taken at 13, 7, 1 h before PCI [ 19 , 20 ]. A 2022 meta-analysis found that among 736 patients who had previously experienced ICM-induced adverse events, starting the premedication protocol helped reduce the incidence of adverse events by an OR 0.09 (0.03–0.25, CI 95%) [ 4 ]. This means that premedication administration before ICM administration is highly recommended in high-risk patients.…”

“…The American College of Radiology (ACR) defines and classifies HSR severity as follows [2]: Severe HSR has a reported incidence of 0.004% to 0.04% [3]. Premedication with antihistamines and corticosteroids is recommended to prevent such adverse reactions, and a 2022 meta-analysis found a significant reduction in adverse events with premedication [4,5].…”

Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward?

“…For at-risk patients, a prophylactic treatment could be implemented (H1-antihistamines, corticosteroids) ( 37 ).…”

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

“…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.…”