Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients

Ann Allergy Asthma Immunol. 2017 Mar;118(3):339-344.e1. doi: 10.1016/j.anai.2016.11.027. Epub 2017 Jan 10.

Abstract

Background: Although the severity of hypersensitivity reactions to iodinated contrast media varies, it is well correlated with the severity of recurrent reactions; however, prophylaxis protocols are not severity-stratified.

Objective: To assess the outcomes of tailored prophylaxis according to the severity of hypersensitivity reactions to iodinated contrast media.

Methods: Our premedication protocols were stratified based on the severity of previous reactions: (1) 4 mg of chlorpheniramine for mild reactions, (2) adding 40 mg of methylprednisolone for moderate reactions, and (3) adding multiple doses of 40 mg of methylprednisolone for severe index reactions. Cases of reexposure in patients with a history of hypersensitivity reactions were routinely monitored and mandatorily recorded.

Results: Among a total of 850 patients who underwent enhanced computed tomography after severity-tailored prophylaxis, breakthrough reactions occurred in 17.1%, but most breakthrough reactions (89.0%) were mild and did not require medical treatment. Additional corticosteroid use did not reduce the breakthrough reaction rate in cases with a mild index reaction (16.8% vs 17.2%, P = .70). However, underpremedication with a single dose of corticosteroid revealed significantly higher rates of breakthrough reaction than did double doses of corticosteroid in cases with a severe index reaction (55.6% vs 17.4%, P = .02). Changing the iodinated contrast media resulted in an additional reduction of the breakthrough reaction rate overall (14.9% vs 32.1%, P = .001).

Conclusion: In a total severity-based stratified prophylaxis regimens and changing iodinated contrast media can be considered in patients with a history of previous hypersensitivity reaction to iodinated contrast media to reduce the risk of breakthrough reactions.

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Aged
  • Contrast Media / adverse effects*
  • Contrast Media / classification
  • Drug Hypersensitivity / diagnosis
  • Drug Hypersensitivity / etiology*
  • Drug Hypersensitivity / prevention & control*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Premedication* / methods
  • Proportional Hazards Models
  • Risk Factors
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Contrast Media