X-ray contrast medium incompatibilityT88.7
Synonym(s)
X-ray contrast medium intolerance
DefinitionThis section has been translated automatically.
X-ray contrast medium intolerance, especially against iodine-containing X-ray contrast media.
ClassificationThis section has been translated automatically.
Iodinated X-ray contrast media are divided into an ionic high osmolar class (e.g. amidotrizoate, meglumin, ioxitalamate) and a non-ionic low osmolar class (e.g. iohexol, iopamidol, ioversol, iopramide, iomeprol, iopentol, iobitridol, iodixanol).
Occurrence/EpidemiologyThis section has been translated automatically.
- Every year, approximately 70 million radiological examinations are performed worldwide with iodinated X-ray contrast media.
- Overall, less severe complications occur after administration of non-ionic low osmolar X-ray contrast media than after administration of ionic high osmolar X-ray contrast media, but the death rates are similar (1/100,000 exposures).
- Prevalence of hypersensitivity reactions of the late type: 0,5-23 %.
- Prevalence of immediate type hypersensitivity reactions:
| severity of complications | Ionic high osmolar RKM | Non-ionic low osmolar RKM |
| easy | Prevalence: 3.8-12.7% | Prevalence: 0,7-3,1%. |
| heavy | Prevalence: 0,1-0,4%. | Prevalence: 0,02-0,04 |
EtiopathogenesisThis section has been translated automatically.
- Iodinated X-ray contrast media can cause anaphylactoid reactions within one hour after administration (immediate type reactions). An IgE-triggered mechanism is often assumed in these cases, but the exact pathophysiological mechanism has not yet been elucidated. Although it is assumed that non-ionic low-osmolar X-ray contrast media cause less anaphylactoid reactions, in practice, prophylactic medication is still administered for premedication.
- Delayed reactions have been described in a period of more than one hour up to 7 days after administration of X-ray contrast media (late-type reactions). Pathophysiologically, they are mediated by T cells.
Clinical featuresThis section has been translated automatically.
- Immediate type hypersensitivity reactions: pruritus, urticaria, angioedema, flush, nausea, vomiting, diarrhea, rhinitis, hoarseness, cough, shortness of breath, hypotension, tachycardia, arrhythmia, shock, cardiac arrest, respiratory arrest.
- Late type hypersensitivity reactions: pruritus, urticaria, angioedema, maculo-papular exanthema, erythema multiforme minor, fixed drug exanthema, Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis, graft-versus-host reaction.
DiagnosisThis section has been translated automatically.
- Prick test with the accused X-ray contrast medium (undiluted) and alternatively with non-ionic lowosmolar X-ray contrast medium (undiluted).
- Intracutaneous test with the incriminated X-ray contrast medium (1:1000 to 1:10 in 0.9% physiological saline solution) and alternatively with non-ionic lowosmolar X-ray contrast media (1:1000 to 1:10 in 0.9% physiological saline solution).
- Epicutaneous test with the accused X-ray contrast medium (undiluted) and alternatively with non-ionic lowosmolar X-ray contrast media (undiluted).
ProphylaxisThis section has been translated automatically.
The results of studies on the prophylactic effect of different premedication regimens are of limited value. The occurrence of anaphylactoid or anaphylactic reactions in the case of renewed administration of X-ray contrast medium even under premedication must be expected in individual cases!
- In the absence of a radiological alternative and prior immediate or late type reaction to an iodinated X-ray contrast medium, as well as in the presence of bronchial asthma, the administration of 32 mg methylprednisolone p.o. is currently recommended 12 hours and 2 hours before renewed administration of X-ray contrast medium. If possible, a non-ionic lowosmolar X-ray contrast medium should be administered, which has been tested negative in the skin tests (prick, intracutaneous, epicutaneous).
- If an immediate renewed administration of X-ray contrast medium is necessary, the combined administration of prednisolone 250 mg i.v., 1 amp. dimetinden (H1-receptor antagonist; 4 ml injection solution) slowly i.v. and 1 amp. cimetidine (H2-receptor antagonist; dilute 4 ml of injection solution with 0.9% NaCl solution to 10 ml; in children and adolescents the strictest indication) slowly i.v.
LiteratureThis section has been translated automatically.
- Brockow K et al (2005) Management of hypersensitivity reactions to iodinated contrast media. Allergy 60: 150-158
- Kvedariene V, Martins P, Rouanet L, Demoly P (2006) Diagnosis of iodinated contrast media hypersensitivity: results of a 6-year period. Clin Exp Allergy 36: 1072-1077
- Tramèr MR, by Elm E, Loubeyre P, Hauser C (2006) Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ 333: 675