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Anaphylaxis to radiographic contrast media

Brockow, Knut; Ring, Johannes

Current Opinion in Allergy and Clinical Immunology: August 2011 - Volume 11 - Issue 4 - p 326–331
doi: 10.1097/ACI.0b013e32834877c3
Anaphylaxis and insect allergy: Edited by Theodore Freeman and Ralf G. Heine

Purpose of review Radiographic contrast media (RCM) are increasingly used in modern diagnostic medicine. Hypersensitivity reactions to nonionic RCM still occur in a significant number of exposed patients, because of the increased use of contrasted radiological investigations. Hypersensitivity reactions may be divided into immediate (<1 h of administration) and nonimmediate responses (>1 h). Immediate reactions present with anaphylaxis.

Recent findings Although described less commonly, anaphylaxis to gadolinium contrast media have been increasingly reported in recent literature. In most patients, immunoglobulin (IgE)-mediated allergy cannot be demonstrated and the underlying mechanism remains unknown. In some patients, positive skin tests, specific IgE antibodies or specific cellular tests have been demonstrated. It may be speculated that more allergic reactions could be described, if more adequate methods were developed. Skin prick tests and intradermal tests with 1 : 10 diluted RCM are specific and confirm the diagnosis of RCM hypersensitivity.

Summary There are not enough data yet about the value of skin tests for the selection of a ‘well tolerated’ RCM. Premedication of previous reactors is common among radiologists. However, breakthrough reactions are a concern and physicians should not rely on the efficacy of pharmacological premedication. Instead, radiologists should be prepared to treat severe RCM-induced allergic reactions in their practice.

aDepartment of Dermatology and Allergology Biederstein, Technische Universität München

bCenter for Allergy and Environment, Technische Universität and Helmholtz Center Munich, Munich, Germany

Correspondence to Knut Brockow, MD, Department of Dermatology and Allergology Biederstein, Technische Universität Munich, Biedersteiner Strasse 29, D-80802 Munich, Germany Tel: +49 89 4140 3182; e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.