{"id":15724,"date":"2022-04-28T07:14:56","date_gmt":"2022-04-28T07:14:56","guid":{"rendered":"https:\/\/interhospi.com\/?p=15724"},"modified":"2022-04-28T07:14:56","modified_gmt":"2022-04-28T07:14:56","slug":"allergic-reaction-to-ct-contrast-media-raises-mri-contrast-risk","status":"publish","type":"post","link":"https:\/\/interhospi.com\/allergic-reaction-to-ct-contrast-media-raises-mri-contrast-risk\/","title":{"rendered":"Allergic reaction to CT contrast media raises MRI contrast risk"},"content":{"rendered":"
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Allergic reaction to CT contrast media raises MRI contrast risk<\/h1>\/ in Featured Articles<\/a> <\/span><\/span><\/header>\n<\/div><\/section>
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People with a history of allergic-like reactions to iodinated contrast media, which is used in a variety of X-ray-based procedures, such as CT and angiography, are susceptible to similar reactions from commonly used MRI contrast agents, according to a large, eight-year study published in the journal Radiology<\/i> [1]. The study also found that premedication or switching to a different MRI contrast agent may reduce risk in patients who have had previous contrast agent reactions.<\/p>\n

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Gadolinium-based contrast agents (GBCA) have long been used to improve visualization of organs, tissues and blood vessels on MRI and provide a more accurate depiction of disease. Although GBCA are relatively safe, recent studies have reported several adverse reactions related to their use, including allergic-like hypersensitivity reactions, such as rash and flushing.<\/p>\n

Increasing incidence of allergic reactions<\/strong><\/h4>\n

The incidence of these reactions is increasing with the widespread use of GBCA, prompting an urgent need for research into risk factors, according to the study\u2019s senior author Hye-Ryun Kang, M.D., Ph.D., from the Department of Internal Medicine at Seoul National University College of Medicine in Seoul, Korea.<\/p>\n

Dr. Kang and colleagues recently analysed more than 330,000 cases of GBCA exposure in 154,539 patients over an eight-year period\u00a0<\/span>at the Seoul National University Hospital. There were 1,304 cases of allergic-like hypersensitivity reactions, for a rate of 0.4%. In patients who had a previous GBCE reaction, the average recurrence rate was 15%.<\/p>\n

Acute allergic-like hypersensitivity reactions, or those that occur within one hour of contrast administration, accounted for 1,178 cases, while a far smaller number of 126 cases were delayed allergic-like hypersensitivity reactions, or those that occur beyond the first hour and mostly within one week after exposure.<\/p>\n

The risk of allergic-like hypersensitivity reactions to GBCAs was higher in those with a history of similar reactions to iodinated contrast media. Traditionally, a history of iodinated contrast media hypersensitivity was not considered as a risk factor for hypersensitivity to GBCAs and vice versa, owing to the structural and compositional differences between the two.<\/p>\n

\u201cThe results of our study challenge this idea,\u201d Dr. Kang said.<\/p>\n

Warning for physicians<\/strong><\/h4>\n

The increased risk may be the result of an underlying predisposition to drug allergies in susceptible patients, Dr. Kang said, rather than any cross-reactivity associated with structural similarities between iodinated contrast media and GBCA. In fact, the risk of hypersensitivity reactions to iodinated contrast media was also higher\u00a0<\/span>in those who previously experienced a similar reaction to GBCA.<\/p>\n

\u201cThus, physicians should be aware that patients with a history of hypersensitivity to one of iodinated contrast media or GBCA are at greater risk of developing hypersensitivity reactions to the other,\u201d she said.<\/p>\n

Preventive premedication<\/strong><\/h4>\n

Analysis of the data showed that premedication, typically with steroids and antihistamines, and changing the GBCA showed preventive effects in patients with a history of acute allergic-like hypersens-itivity reactions. Patients who received premedication and before MRI or were switched to a different GBCA showed the lowest rate of recurrence. Only premedication significantly reduced the incidence of reactions in patients with a history of delayed reactions.<\/p>\n

\u201cAs the most important preventive measure is avoidance of the culprit agent, a precise record of previously used GBCA should be kept for all patients,\u201d Dr. Kang said. \u201cPhysicians should discuss appropriate premedication strategies with their patients prior to MRI procedures.\u201d<\/p>\n

Dr. Kang emphasized that contrast-enhanced MRI examinations are invaluable in the diagnosis and follow-up of various diseases, and the overall risk remains low.<\/p>\n

\u201cAs most of these reactions are mild, we believe the benefits of MRI outweigh the potential risks associated with GBCA use,\u201d she said.<\/p>\n

Dr. Kang advises that in all patients receiving an MRI with GBCA exposure, a detailed history of previous hypersensitivity allergic reactions be conducted, and when necessary, appropriate prevention measures such as using premedication and switching to different types of GBCA should be implemented.<\/p>\n

The researchers hope to conduct future studies with larger populations to identify possible risk factors and effective preventive strategies for delayed hypersensitivity reactions to GBCA.<\/p>\n<\/div><\/section>
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References<\/strong><\/p>\n

1. Yoon Hae Ahn, Dong Yoon Kang, Soo-Been Park, et al. Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154\u2009539 Patients. Radiology, 2022; doi: http:\/\/doi.org\/10.1148\/radiol.210545<\/a>\u00a0<\/span><\/em><\/p>\n

2. David F. Kallmes, Jennifer M. McDonald. Practical Messages from Large Database Studies of Contrast Media Reactions. Radiology, 2022; doi: http:\/\/doi.org\/10.1148\/radiol.220052<\/a>\u00a0<\/span><\/em><\/p>\n<\/div><\/section>
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