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Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

Lee SY1,2, Kang DY3, Kim JY4, Yoon SH5, Choi YH5, Lee W4, Cho SH1,2,3, Kang HR1,2,3

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) : 444-450
doi: 10.18176/jiaci.0374

Objectives: We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM.
Methods: This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS).
Results: The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had 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 LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not.
Conclusion: The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM.

Key words: Contrast media, Hypersensitivity, Incidence, Risk Factors, Secondary prevention