Prevalence of Adverse Reactions to Radiopaque Contrast Reported by Patients Presenting for Interventional Pain Procedure

Abstract

Introduction: Adverse reactions to radiopaque contrast media (RCM) are well documented with a wide range of incidences reported. The objective of this study was to determine how many patients in a sample of 200 who presents for interventional pain treatments report a history of adverse reactions to RCM. Methods: Data from 200 outpatients were collected using a self‐administered questionnaire. The questionnaire was designed to obtain information about prior exposure to RCM and any adverse events plus other general information about allergic reactions including known risk factors for allergic reactions. Demographic data and information about past medical history were obtained from each patient. Results: Of the 200 patients surveyed, 16 reported having had an allergic reaction to RCM. The events met criteria for immediate hypersensitivity reaction. Chemotoxic reactions cannot be ruled out. Of factors associated with risk of allergic reaction, none were clearly more prevalent in subjects reporting an allergic reaction vs. subjects who did not. Atopic patients generally considered susceptible to contrast allergy reported no hypersensitivity reaction. The number of medications and foods the subjects reported caused them to have allergic reactions was extensive. Conclusion: Patients with a history suggestive of an immediate hypersensitivity reaction to RCM may report for interventional pain procedures normally performed with RCM. Patients who have experienced an immediate hypersensitivity reaction to RCM have increased risk for another reaction if injected again with contrast agent. Therefore, facilities should be prepared to implement measures to prevent recurrent reactions.

Patients with a history of hypersensitivity reaction to iodinated contrast medium and given iodinated contrast during an interventional pain procedure

“…In response to a self-administered questionnaire, patients reported a prevalence of 8% adverse reactions (16 of 200) to ICM. The symptoms included pruritus, rash, shortness of breath and generalized pain 8. Limitations of this study include the lack of confirmation of the symptoms, assumption that the contrast was low osmolality and non-ionic, and the patients’ considering all their symptoms as HRs.…”

The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions

“…In an earlier study, 16 of 200 patients (8%) who presented to a pain clinic reported a previous “allergic reaction.” However, their symptoms included generalized pain, sneezing, cough, and glossitis. 96 In another study, there were 10 cases out of “allergic reactions” of 26,061 (0.038%) interventional pain procedures. 97 In this investigation, the number of interventions in which contrast were used and the specific contrast used were not stated.…”

Absence of Iodinated Contrast Hypersensitivity and Characterization of Gadolinium Utilization in an Interventional Pain Population

“…Even in the absence of intravascular spread, systemic uptake of ICM does occur during pain procedures with the potential for HSRs. Historical ICM allergy was documented in 16 of 200 patients (8%) presenting for interventional pain procedures requiring contrast 3 . The management of ICM allergy labels in this setting centers on 2 options: (1) preemptive administration of steroid premedication, or (2) substitution of ICM with non‐iodinated contrast (gadolinium).…”