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Incidence and risk factors of low-osmolar iodinated contrast media related immediate hypersensitivity reactions: A longitudinal study based on a real-time monitoring system

Suh-Young L1,2, Dong Yoon K3, Ju-Young K4, Soon Ho Y5, Young-Hoon C5, Whal L4, Sang Heon C1,2,3, Hye-Ryun K1,2,3

1Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
2Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
3Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
4Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
5Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

J Investig Allergol Clin Immunol 2019; Vol. 29(6)
doi: 10.18176/jiaci.0374

Objectives: We investigated the incidence of immediate hypersensitivity reaction (HSR) focusing on the types of low osmolar contrast media (LOCM) and accumulated exposures to LOCM.
Methods: This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography scan from 2012 through 2014. Five LOCMs (iobitridol, iohexol, iomeprol, iopamidol, and iopromide) were used. All patients were monitored for adverse events and new symptoms and signs were recorded in the Contrast Safety Monitoring and Management System (CoSM2oS) in real-time.
Results: The overall incidence of immediate HSR to LOCM was 0.97% (2,004 events resulting from 205,726 exposures). Incidence was significantly different depending on the presence of a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P =.001). The incidence of HSR to individual LOCMs ranged from 0.72% (iohexol) to 1.34% (iomeprol), but there were no significant differences across the five LOCMs. A longitudinal analysis demonstrated that the incidence of HSR gradually increased with increased previous exposure to LOCM (HR=2.006 (1.517-2.653), P <.001). However, this accumulated increase in risk was observed in subjects who had experienced HSR to LOCM, but not in subjects who had never experienced LOCM-induced HSR before.
Conclusion: The incidence of HSR was not significantly different across the five LOCMs used in the study. Repeated exposure to LOCM did not increase the risk of HSR among subjects who never experienced HSR to LOCM.

Key words: Contrast Media, Hypersensitivity, Incidence, Risk Factors, Secondary Prevention