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Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Rosado Ingelmo A1, Doña Diaz I2, Cabañas Moreno R3, Moya Quesada MC4, García-Avilés C5, García Nuñez I6, Martínez Tadeo JI7, Mielgo Ballesteros R8, Ortega-Rodríguez N9, Padial Vilchez MA10, Sánchez-Morillas L11, Vila Albelda C1, Moreno Rodilla E12*, Torres Jaén MJ2*

1Unidad de Alergia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
2Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Málaga, Spain
3Department of Allergy, Hospital La Paz, Health Research Institute (IdiPAZ), Madrid, Spain
4Sección de Alergia CH Torrecárdenas, Almería, Spain
5Unidad de Alergia, Hospital Moncloa, Madrid, Spain
6Servicio de Alergología, Hospital Quirón Málaga, Málaga, Spain
7Servicio de Alergología, Hospital Universitario Ntra Sra de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
8Servicio de Alergología, Hospital Universitario 12 de Octubre, Madrid, Spain
9Servicio de Alergia, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
10Servicio de Alergologia, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
11Servicio de Alergologia, Hospital Clínico San Carlos, Madrid, Spain
12Servicio de Alergología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
*Both authors contributed equally to this study.
On behalf of the Drug Allergy Committee of Spanish Society of Allergy and Clinical Immunology (SEAIC)

J Investig Allergol Clin Immunol 2016; Vol 26(3) : 144-155
doi: 10.18176/jiaci.0058

The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature.
The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections.
The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%).
Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity.
Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported.

Key words: Iodinated. Gadolinium. Contrast media. Allergy. Hypersensitivity. Anaphylaxis. Immediate reactions. Nonimmediate reactions.