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Akiko Jingu: pj. This article has been cited by other articles in PMC. Abstract Background Adverse reactions to iodinated and gadolinium contrast media are an important clinical issue. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions, some patients may have reactions to contrast media in spite of premedication breakthrough reaction; BTR. The purpose of this study was to assess the frequency, type and severity of BTR when following an oral steroid premedication protocol.
Methods All iodinated and gadolinium contrast-enhanced radiologic examinations between August and February for which the premedication protocol was applied in our institution were assessed for BTRs. Results The protocol was applied to a total of examinations patients, ages 15—87 years; 63 males, 90 females.
Of these, were for prior acute adverse reactions to contrast media, 85 were for a history of bronchial asthma, and 15 were for other reasons. There were nine BTR 4. Conclusion Incidence of BTRs when following the premedication protocol was low. This study by no means proves the efficacy of premedication, but provides some support for following a premedication protocol to improve safety of contrast-enhanced examinations when prior adverse reactions are mild, or when there is a history of asthma.
Keywords: Iodinated contrast media, Gadolinium contrast media, Breakthrough reaction, Acute adverse reaction Background Intravenous contrast media are essential for modern medical imaging. Two of the most common intravenous contrast media are iodinated contrast media for computed tomography CT and angiography, and gadolinium contrast media for magnetic resonance imaging MRI. These contrast media are relatively safe, but adverse reactions to contrast media are still an important clinical issue.
Patient-related risk factors for acute adverse reactions to these contrast media have been established, i. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions [ 1 , 2 ], some patients may have reactions to contrast media in spite of premedication breakthrough reaction; BTR [ 3 - 5 ].
The efficacy of premedication is still unclear, and in particular the frequency of BTR after gadolinium contrast media administration has been little reported.
In our institution, as a general rule, patients with a history of severe or moderate adverse reactions to contrast do not undergo contrast-enhanced examinations. Those with a history of mild reactions or a history of bronchial asthma will undergo contrast-enhanced examinations only when they have received oral premedication. The purpose of this study was to assess the frequency, type and severity of BTR, following oral steroid premedication protocol.
Institutional review board Gunma University Graduate School of Medicine Human Research Committee approval was obtained, and it was determined that informed patient consent was not required because of the retrospective nature of this study.
We did not include interventional radiology cases. The frequent use of additional drugs including embolization materials, chemotherapeutic agents and sedatives , and the complexity of the procedures make it difficult to determine the cause of any adverse reactions. All contrast-enhanced CT and MRI examinations following the premedication protocol were recorded using forms designated by our department.
All adverse reactions occurring in our department were evaluated by a radiologist in charge, and the type, severity, treatment and outcome of the reactions were recorded. Both index reaction IR the reaction prompting the use of oral premedication and BTR were recorded using the same grading system. If premedication was administered according to the protocol of our department, the repeated reaction was considered a BTR. When an acute adverse reaction occurred, patients were usually observed in our hospital for at least one hour.
The former does not differentiate severity and simply states history of reaction as a risk factor. The latter, on the other hand, states moderate to severe reactions as risk factors, and does not consider mild reactions an indication for premedication. Our own original premedication protocol is followed for patients with a history of mild adverse reactions, a history of bronchial asthma regardless of severity, or a history of allergies requiring medical treatment.
The protocol is as follows: 1. Patients with a history of mild adverse reactions, history of bronchial asthma regardless of severity , or a history of allergies requiring medical treatment will undergo contrast enhanced examinations if premedicated as follows: 1 Methylprednisolone Medorol: Pfizer Co.
Patients with a history of moderate or severe adverse reactions to contrast media should not undergo contrast-enhanced examinations, with or without premedication. This is optional, and contraindicated for glaucoma and benign prostatic hypertrophy. Patients with a history of moderate or severe adverse reactions to contrast media are not the target of the protocol, and usually do not undergo a contrast-enhanced examination.
In our hospital, the decision to perform the protocol is made by a physician who orders a radiological examination, if necessary after discussion with a radiologist. We use four kinds of iodinated contrast media. They are Iopamidol Iopamiron; Bayer Co. Three kinds of gadolinium contrast media are used, which are Gadoterate meglumine Magnescope; Terumo Co.
Although there are few data to support changing the contrast media to decrease the likelihood of a subsequent reaction in patients with a history of prior allergic-like reactions to iodinated contrast media, we usually change the contrast media administered in such cases. During this time, a total of 61, examinations 41, CTs, 20, MRIs were performed in our institution.
The total number of adverse reactions to iodinated contrast media during this period with and without premedication was , or 0. The total number of adverse reactions to gadolinium contrast media during this period was 26 or 0. The reasons for following the premedication protocol were a history of acute adverse reactions to iodinated contrast media in examinations, a history of acute adverse reactions to gadolinium contrast in six examinations, a history of asthma in 64 examinations, and suspected delayed adverse reaction to iodinated contrast media in 11 examinations.
The prior adverse reactions were mild for examinations, moderate for six, and severe for zero. Among these examinations in patients, there were BTRs in nine examinations 4.
ESUR Guidelines on Contrast Media - European Society of Urogenital Radiology