Prevention of generalized reactions to contrast media: a consensus report and guidelines

Abstract

The aim of this study was to document, using consensus methodology, current practice for prevention of generalized reactions to contrast media, to identify areas where there is disagreement or confusion and to draw up guidelines for reducing the risk of generalized contrast media reactions based on the survey and a review of the literature. A document with 165 questions was mailed to 202 members of the European Society of Urogenital Radiology. The questions covered risk factors and prophylactic measures for generalized contrast media reactions. Sixty-eight members (34%) responded. The majority indicated that a history of moderate and severe reaction(s) to contrast media and asthma are important risk factors. The survey also indicated that patients with risk factors should receive non-ionic contrast media. In patients at high risk of reaction, if the examination is deemed absolutely necessary, a resuscitation team should be available at the time of the procedure. The majority (91%) used corticosteroid prophylaxis given at least 11 h before contrast medium to patients at increased risk of reaction. The frequency of the dosage varied from one to three times. Fifty-five percent also use antihistamine Hl, mainly administered orally and once. Antihistamine H2 and ephedrine are rarely used. All essential drugs are available on the emergency resuscitation trolley. Patients with risk factors are observed up to 30 min by 48% and up to 60 min by 43% of the responders. Prophylactic measures are not taken before extravascular use of contrast media. Prophylactic drugs are given to patients with a history of moderate or severe generalized reaction to contrast media. In patients with asthma, opinion is divided with only half of the responders giving prophylactic drugs. Aspirin, beta-blockers, interleukin-2 and non-steroid anti-inflammatory drugs are not considered risk factors and therefore are not stopped before injection of contrast media. The survey showed some variability in rating of risk factors for generalized contrast medium reactions, and marked variability in the prophylactic measures used. There remain major areas of uncertainty, and there is insufficient data in the literature to guide practice. Some simple guidelines for prophylaxis of generalized contrast medium reactions are proposed.

Recent hot topics in contrast media

“…Immediate reactions are the same for all types of contrast media (ultrasound agents, MR-agents and X-ray agents) and they have been recognized for many years [27,28]. The change from ionic high-osmolar to non-ionic iodine based contrast media reduced the incidence of reactions, with the result that there is now much less experience of treating moderate and severe acute non-renal reactions.…”

Diretrizes SBC: ressonância e tomografia cardiovascular

“…Para a prevenção de efeitos adversos aos contrastes utilizados na angiotomografia, deve-se sempre preconizar a boa hidratação do paciente (tanto na forma oral quanto endovenosa em casos selecionados) . Além disso, a utilização de corticóides e antihistamínicos em pacientes com reações anteriores também é recomendada 400 . Finalmente, para a prevenção da nefrotoxicidade renal, além da hidratação já mencionada, também pode-se utilizar acetilcisteína no dia anterior e após o estudo, embora os resultados de diversos estudos ainda sejam inconsistentes 401 .…”

X-Ray Contrast Media

“…In cancer patients treated with interleukin-2, more side-effects have been observed after administration of ionic and nonionic contrast media. These side-effects include fever, nausea, vomiting, skin reactions, and diarrhea [66]. On the other hand, butylscopolamine appears to have no influence on contrast medium tolerance [67].…”