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Fukushima Y, Ozaki D, Taketomi-Takahashi A, Hirasawa H, Ujita K, Suto T, Tsushima Y. Assessment of first-time and repeated acute adverse reactions to gadolinium-based contrast agents in MRI: A retrospective study. Eur J Radiol 2024; 176:111504. [PMID: 38761445 DOI: 10.1016/j.ejrad.2024.111504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To identify gadolinium-based contrast agents (GBCAs)-related and patient-related risk factors for acute adverse reactions (AARs), and to examine the incidence and severity of repeated AARs. METHODS This study retrospectively evaluated all intravenous GBCA injections in MRI studies at a single institution from January 2012 to September 2019. First-time AARs in patients without a past history of AARs and risk factors were assessed using multivariable regression models with generalized estimating equations. For patients with a past history of AAR(s), we evaluated the incidence of repeated AARs using the Fisher's exact test, as well as the severity of these repeated AARs. RESULTS First-time AARs occurred in 129 of 41,827 GBCA injections (0.31 %; 0.70 % of 18,431 patients). With gadoterate meglumine as the reference, the odds ratio (OR) for allergic-like reactions to three GBCAs ranged from 3.27 to 8.03 (p = 0.012 to <0.001). For chemotoxic reactions, the OR was 3.75 (p = 0.001) for gadoteridol. Outpatients had a lower OR for chemotoxic reactions, while higher ORs were observed in head/neck and breast MRI (p < 0.05). The OR for age was 0.99 (p < 0.05). Patients with a past history of AAR(s) had a 3.6 % incidence of mild repeated AARs for all GBCA, significantly higher than the 0.31 % in first-time AARs (p < 0.001). No effectiveness was found for steroid premedication. CONCLUSION The occurrence of first-time AARs was related to the GBCA used and other factors. The incidence of repeated AARs was higher than first-time AARs, though all were mild in severity.
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Affiliation(s)
- Yasuhiro Fukushima
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Daisuke Ozaki
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Hiromi Hirasawa
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Koichi Ujita
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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Vega F, van de Ven AAJM, van der Molen AJ. Cross-reactivity in hypersensitivity reactions to contrast agents: new classification and guide for clinical practice. Eur Radiol 2024:10.1007/s00330-024-10872-8. [PMID: 38937294 DOI: 10.1007/s00330-024-10872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Francisco Vega
- Department of Allergy, Hospital Universitario de la Princesa, Madrid, Spain
| | - Annick A J M van de Ven
- Department of Internal Medicine, Division of Allergology, University Medical Center Groningen, Groningen, The Netherlands
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Nitta K, Matsumoto K, Yokota H, Murata T, Masuda Y, Uno T. Relationship Between Patient-Friendly Audiovisual Systems and MRI Contrast Agent to Adverse Reactions. J Magn Reson Imaging 2024; 59:2013-2020. [PMID: 37572088 DOI: 10.1002/jmri.28951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Patient-friendly audiovisual (AV) systems in head MRI examinations can potentially reduce patient anxiety and contrast-enhanced MRI (CE-MRI) adverse reactions to gadolinium. PURPOSE To evaluate whether a patient-friendly AV system reduces the rate of adverse reactions to gadolinium-based contrast agents. STUDY TYPE Retrospective. POPULATION Four thousand eight hundred thirty-two outpatients (2462 female) attending for clinical CE-MRI studies. (Gadoteridol: 1971, Meglumine gadoterate: 2733, Gadobutrol: 128.) FIELD STRENGTH/SEQUENCE: Routine CE-MRI of head and neck using a 1.5 T or 3 T scanner with or without a patient-friendly AV system. ASSESSMENT One thousand one hundred fifty-nine patients were scanned on MRI machines equipped with patient-friendly AV systems (AV group) and 3673 on MRI machines without AV systems (control group). Adverse reaction rate and symptoms were reviewed by referring to the system database and electronic medical records and compared between the two groups. Adverse reactions were defined as physiological reactions, such as vomiting and allergic-like reactions, such as urticaria, occurring within 1 hour of contrast injection. We compare patient backgrounds, adverse reaction rate, adverse reactions symptoms and the severity between the two groups. STATISTICAL TESTS Adverse reaction rate with and without a patient-friendly AV system were compared using Fisher's exact test. The relationship between patient-friendly AV systems and the occurrence of adverse reactions was evaluated with logistic regression. Statistical significance was set at P < 0.05. RESULTS Of the 4832 patients enrolled, 65 (1.35%) experienced adverse reactions. The most common adverse reactions in both groups were urticaria and pruritus. Adverse reaction rate was significantly lower in the AV group than in the control group (0.7% vs. 1.6%). No significant difference was observed in the severity (P = 1.000) of adverse reactions and symptoms (allergic-like reaction: P = 0.08, physiologic reaction: P = 1.000) between the two groups. DATA CONCLUSION The patient-friendly AV system significantly reduce adverse reaction occurrence to gadolinium-based contrast agents. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Keisuke Nitta
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Taisuke Murata
- Department of Radiology, Chiba University Hospital, Chiba, Japan
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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4
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Sáenz de Santa María R, Labella M, Bogas G, Doña I, Torres MJ. Hypersensitivity to gadolinium-based contrast. Curr Opin Allergy Clin Immunol 2023; 23:300-306. [PMID: 37357781 DOI: 10.1097/aci.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The use of contrast media is increasing in recent decades. Although gadolinium-based contrast agents (GBCAs) are generally well tolerated, adverse reactions, including hypersensitivity reactions (HSRs), although infrequent, may occur. It is important to perform a thorough allergological evaluation in patients with suspected GBCA-HSRs to avoid potentially serious reactions in subsequent exposures. RECENT FINDINGS Data on GBCA-HSRs are scarce. Most published articles dealing with skin tests and drug provocation tests (DPTs) with GBCAs are case series and small cohorts. Controversies exist about the role of premedication for preventing HSRs on subsequent exposures. Selection of well tolerated alternatives is based on potential cross-reactivity among GBCAs; however, the extent of cross-reactivity among them remains unclear. SUMMARY As premedication is not useful because breakthrough reactions are frequent in patients with GBCA-HSRs in subsequent exposures, an allergological evaluation is required. Available data suggest a high negative predictive value of skin tests, being crucial for guiding the selection of an alternative GBCA. However, DPTs are still necessary to confirm or exclude the diagnosis or find alternative GBCAs. Cross-reactivity is high among GBCAs belonging from the same group, mainly among macrocyclic compounds, so this must be taken into account for selecting alternatives.
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Affiliation(s)
- Rocío Sáenz de Santa María
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Marina Labella
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Gádor Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Inmaculada Doña
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - María José Torres
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
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Cabrera CM, Clarcast M, Palacios-Cañas A. Clinical validation of the basophil activation test in immediate hypersensitivity reactions to gadolinium-based contrast agents. Int Immunopharmacol 2023; 117:110000. [PMID: 37012878 DOI: 10.1016/j.intimp.2023.110000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
Gadolinium based contrast agents (GBCAs) are safe compounds globally used in magnetic resonance imaging (MRI). However, in last years it has been detected an increase of immediate hypersensitivity reactions (IHRs) to them. Diagnosis of IHRs to GBCAs is based on clinical symptoms, skin tests (STs) and drug provocation test (DPT). But DPTs are not without risks, thus it is important to implement an in vitro alternative method such as the basophil activation test (BAT). We described the clinical validation of the BAT using ROC curves from a control population formed by 40 healthy individuals without previous reactions to any contrast agents and 5 patients suffering from IHRs to GBCAs. Four patients presented IHRs to gadoteric acid (GA) as the culprit agent and another one to gadobutrol (G). Basophil reactivity was measured in percentage of CD63 expression and in stimulation index (SI). The optimal cut-off with the highest sensitivity (S) and specificity (E) for the GA was of 4.6% at 1:100 dilution (S = 80% and E = 85%; AUC = 0.880, p = 0.006). For the SI with GA, the cut-off of highest sensitivity and specificity was of 2.79 at 1:100 dilution (S = 80% and E = 100%; AUC = 0.920, p = 0.002). Sensitivity did not show differences between STs regarding the BAT (p < 0.05). Moreover, the BAT was able to detect one case with IHR to GA which had negative STs. Therefore, the BAT is a useful method in diagnosis of IHRs to GBCAs.
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McDonald JS. Contrast Agent Substitution to Prevent Repeat Adverse Reactions. Radiology 2022; 305:350-352. [DOI: 10.1148/radiol.221477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer S. McDonald
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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7
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Kallmes DF, McDonald JS. Practical Messages from Large Database Studies of Contrast Media Reactions. Radiology 2022; 303:337-338. [PMID: 35191744 DOI: 10.1148/radiol.220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David F Kallmes
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jennifer S McDonald
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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8
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Severity of Flare Reactions in Diethylenetriamine Pentaacetate Chelations: Report on Different Immune Dampening Strategies in Clinical Practice. Invest Radiol 2022; 57:293-300. [PMID: 34935653 DOI: 10.1097/rli.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to report early clinical experience with various forms of immune dampening to mitigate the expected flare reaction in patients suffering from gadolinium deposition disease (GDD) receiving DTPA chelation. MATERIALS AND METHODS All patients were clinical subjects, and no prospective research was performed on them. The study included 31 consecutive patients (21 women; age, 46.2 ± 12.5 years). The diagnosis of GDD was clinically made. The severity of the flare over the week after each chelation session was rated on a scale from 1 to 10 (where 1 is negligible, 10 is intolerably severe). Patients were followed for up to 5 chelation sessions. Four immune dampening strategies were used: (1) no concurrent treatment; (2) antihistamine plus montelukast (AH); (3) steroid/antihistamine taper postchelation (SAHT); and (4) steroid/antihistamine extending from prechelation to 5 days postchelation (extended hypersensitivity medication regimen; EHMR). The data were analyzed with generalized linear mixed models and with linear regression. RESULTS A total of 102 flare scores were obtained at different time points. Ten patients underwent 5 chelations. The severity of the flare after the first chelation was significantly higher in cases of no concurrent therapy (8.4 ± 2.6) and AH (7 ± 1.4) compared with SAHT (6 ± 1.3) and EHMR (5 ± 1.1). Patients who underwent SAHT and EHMR experienced less severity of flare after the first chelation (P = 0.0049 and P = 0.0005, respectively). Considering all time points, the results were also significantly better with SAHT and EHMR. CONCLUSION Based on early clinical experience, EHMR seems to manage flare reactions in DTPA chelation well. This strategy may represent the first standard therapy in patients with GDD.
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9
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Lang M, Deng F, Singh R, DeFuria CL, Saini S, Alkasab TK. Implementation of a Semistructured Clinical Event Documentation Tool for Acute Adverse Contrast Reactions. J Am Coll Radiol 2022; 19:655-662. [PMID: 35339456 DOI: 10.1016/j.jacr.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/12/2022] [Accepted: 02/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To improve the efficiency and accuracy of clinicians documenting acute clinical events related to contrast agent administration using a web browser-based semistructured documentation support tool. METHODS A new tool called CISaR (Contrast Incident Support and Reporting) was developed to enable radiologists responding to contrast reactions to document inciting contrast class, type of event, severity of contrast reaction, and recommendation for future contrast use. Retrospective analysis was conducted of all CT and MRI examinations performed between February 2018 and December 2019 across our hospital system with associated contrast reaction documentation. Time periods were defined as before tool deployment, early adoption, and steady-state deployment. The primary outcome measure was the presence of event documentation by a radiologist. The secondary outcome measure was completeness of the documentation parameters. RESULTS A total of 431 CT and MRI studies with reactions were included in the study, and 50% of studies had radiologist documentation during the pre-CISaR period. This increased to 66% during the early adoption period and 89% in the post-CISaR period. It took approximately 9 months from the introduction of CISaR to reach full adoption and become the main method for adverse contrast reaction documentation. The percentage of radiologist documentation that detailed provoking contrast agent class, severity of reaction, reaction type, and future contrast agent recommendation all significantly increased (P < .0001), with greater than 95% inclusion of each element. CONCLUSION The implementation of a semistructured electronic application for adverse contrast reaction reporting significantly increased radiologist documentation rate and completeness of the documentation.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis Deng
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramandeep Singh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cathryn L DeFuria
- Radiology Quality and Patient Safety Officer, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sanjay Saini
- Vice Chair for Quality, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tarik K Alkasab
- Associate Chair for Enterprise Informatics/IT, Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts.
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Gracia Bara MT, Gallardo-Higueras A, Moreno EM, Laffond E, Muñoz Bellido FJ, Martin C, Sobrino M, Macias E, Arriba-Méndez S, Castillo R, Davila I. Hypersensitivity to Gadolinium-Based Contrast Media. FRONTIERS IN ALLERGY 2022; 3:813927. [PMID: 35386665 PMCID: PMC8974732 DOI: 10.3389/falgy.2022.813927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are frequently used in magnetic resonance imaging (MRI) examinations to increase sensitivity in diagnoses. Recently, an increase in the description of hypersensitivity reactions to GBCAs has been detected. We performed research in PubMed, PubMed, SCOPUS, and EMBASE until September 2021, searching for studies regarding immediate and delayed hypersensitivity reactions to gadolinium-based contrast agents in which an allergy study was performed. The initial research identified 149 articles written in English. After excluding articles duplicated and articles that had irrelevant designs, 26 articles were included. Finally, 17 studies concerning immediate reactions, six studies concerning non-immediate reactions, and three concerning both that performed allergy evaluations were selected. In the review, we analyzed the characteristics of immediate and delayed reactions and the results of the allergy study and cross-reactivity. Skin tests seem to have acceptable accuracy, but drug provocation tests are still needed when skin tests are negative o to find alternative agents. Although cross-reactivity patterns are not well established, cross-reactivity seems to exist among macrocyclic agents. Notwithstanding, the number of patients analyzed is low and further studies are required. A management algorithm is suggested.
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Affiliation(s)
- M. Teresa Gracia Bara
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
| | | | - Esther M. Moreno
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
- RETIC Asma, Reacciones Adversas y Alérgicas (ARADYAL), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Laffond
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Francisco J. Muñoz Bellido
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Cristina Martin
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
| | - Miriam Sobrino
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
| | - Eva Macias
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Sonia Arriba-Méndez
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | | | - Ignacio Davila
- Allergy Service, University Hospital, Salamanca, Spain
- Institute of Biomedical Research, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
- RETIC Asma, Reacciones Adversas y Alérgicas (ARADYAL), Instituto de Salud Carlos III, Madrid, Spain
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Ahn YH, Kang DY, Park SB, Kim HH, Kim HJ, Park GY, Yoon SH, Choi YH, Lee SY, Kang HR. Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154 539 Patients. Radiology 2022; 303:329-336. [PMID: 35191737 DOI: 10.1148/radiol.210545] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background With the widespread use of gadolinium-based contrast agents (GBCAs), the incidence of allergic-like hypersensitivity reactions (HSRs) to GBCAs is increasing. Research on the incidence and risk factors for HSRs to GBCAs is needed for their safe use. Purpose To determine the incidence of acute and delayed reactions to GBCAs and to discuss the risk factors and strategies for the prevention of HSRs to GBCAs. Materials and Methods All cases of HSRs to contrast media that occurred at the Seoul National University Hospital from July 1, 2012, to June 30, 2020, were assessed. Information including age, sex, GBCA type, onset, and severity of HSRs was retrospectively analyzed. Results Among the 331070 cases of GBCA exposure in 154539 patients, 1304 cases of HSRs (0.4%) were reported. Acute HSRs accounted for 1178 cases (0.4%), while 126 cases (0.04%) were delayed HSRs. While both premedication (odds ratio [OR] = 0.7, P = .041) and changing the type of GBCA (OR = 0.2, P < .001) showed preventative effects in patients with a history of acute HSRs, only premedication (OR = 0.2, P = .016) significantly reduced the incidence of HSRs in patients with a history of delayed reactions. The risk of an HSR to GBCA was higher in those with a history of an HSR to iodinated contrast media (OR = 4.6, P < .001). Conclusion The rate of hypersensitivity reactions (HSRs) to gadolinium-based contrast agents (GBCAs) was 0.4%. The absence of premedication, repeated exposures to the culprit GBCA, and a history of HSRs to iodinated contrast media and GBCAs were risk factors for HSRs to GBCAs. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kallmes and McDonald in this issue.
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Affiliation(s)
- Yoon Hae Ahn
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Dong Yoon Kang
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Soo-Been Park
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Hyun Hwa Kim
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Hyun Jee Kim
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Ga-Yoon Park
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Soon-Ho Yoon
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Young-Hun Choi
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Suh Young Lee
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
| | - Hye-Ryun Kang
- From the Departments of Internal Medicine (Y.H.A., S.Y.L., H.R.K.) and Radiology (S.H.Y., Y.H.C.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Drug Safety Monitoring Center and Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea (D.Y.K., S.B.P., H.H.K., H.J.K., G.Y.P., S.Y.L., H.R.K.); and Institute of Allergy and Clinical Immunology, Seoul National University, Seoul, Korea (S.Y.L., H.R.K.)
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Walker D, McGrath TA, Glikstein R, Chakraborty S, Blanchette C, Schieda N. Empiric Switching of Gadolinium-Based Contrast Agents in Patients With History of Previous Immediate Hypersensitivity Reaction to GBCA: A Prospective Single-Center, Single-Arm Efficacy Trial. Invest Radiol 2021; 56:369-373. [PMID: 33337738 DOI: 10.1097/rli.0000000000000750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breakthrough hypersensitivity reactions (HRs) to gadolinium-based contrast agent (GBCA) occur in 40% of patients despite corticosteroid premedication. Other strategies to reduce HRs are not well studied. OBJECTIVE The aim of this study was to prospectively evaluate HR rate to GBCA among patients with history of HR to GBCA, empirically given an alternative GBCA prior to repeat administration. MATERIALS AND METHODS From September 2019 to September 2020, patients with prior HR to GBCA received 13-hour oral corticosteroid and diphenhydramine premedication prescription with switching of GBCA to gadoterate (previously unavailable at our institution before September 2019). Power analysis (α error, 0.05; β error, 0.80) determined 21 patients were required. Patients were evaluated under a quality assurance waiver from the institutional review board. A radiologist documented the nature of initial HR and inciting GBCA, premedication received, incidence, and severity of breakthrough HR. RESULTS After exclusions, we evaluated 26 patients with mild (92.3% [24/26]) or moderate (7.7% [2/26]) HR to gadobutrol (53.8% [14/26]), gadoxetate (3.8% [1/26]), and gadopentetate (3.8% [1/26]). In 38.5% (10/26), inciting GBCA was unknown but was likely gadobutrol or gadopentetate based on availability. There were 22 females. The mean patient age was 52.1 ± 15.8 years.From 27 gadoterate administrations, 59.3% (16/27) patients received corticosteroid and diphenhydramine premedication, 11.1% (3/27) received only diphenhydramine, and 29.6% (8/27) with no premedication.Hypersensitivity reaction rate after empiric switching to gadoterate was 3.7% (1 mild reaction; 95% confidence interval [CI], 0.09%-18.9%) overall with no difference in patients with (6.3% [1/16]; 95% CI, 0.15%-28.7%) or without (0%; [0/11] upper bound 95% CI, 25.0%) corticosteroid premedication. CONCLUSIONS In this prospective single-arm study, empirically switching GBCA to gadoterate in patients with prior HR to GBCA substantially reduced the expected rate of subsequent HRs in patients with and without the use of corticosteroid premedication. IMPLICATIONS FOR PATIENT CARE Empirically switching GBCAs, with or without the use of corticosteroid premedication, can substantially reduce the rate of hypersensitivity breakthrough reactions.
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Affiliation(s)
- Daniel Walker
- From the Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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Bansie RD, Karim AF, van Maaren MS, Hermans MA, van Daele PLA, Gerth van Wijk R, Rombach SM. Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review. Int J Immunopathol Pharmacol 2021; 35:20587384211015061. [PMID: 34053316 PMCID: PMC8170298 DOI: 10.1177/20587384211015061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. METHODS A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. RESULTS Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%-9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%-34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. CONCLUSION In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.
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Affiliation(s)
- Rakesh D Bansie
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.,Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - A Faiz Karim
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.,Department of Internal Medicine, Section Allergy and Clinical Immunology, Gouda Groene Hart Ziekenhuis, Zuid-Holland, the Netherlands
| | - Maurits S van Maaren
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Maud Aw Hermans
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Paul LA van Daele
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Saskia M Rombach
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
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