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Single-Center Retrospective Analysis of Breakthrough Allergic-Like Reactions to Gadobutrol

Walker, Daniel MD, MSc; Chakraborty, Santanu MBBS, MRCP, DMRD, FRCR; Schieda, Nicola MD, FRCPC

doi: 10.1097/RLI.0000000000000557
Original Articles

Objective The purpose of this study was to assess the rate and severity of breakthrough allergic-like reactions to gadobutrol.

Materials and Methods Under a waiver from our institutional review board, we performed a key word search of our institutional PACS (Picture Archiving and Communication System) database to identify all allergic-like reactions, which occurred in the setting of gadobutrol administration between December 2009 and August 2018, encompassing approximately 25,000 gadobutrol injections. Patients with an index allergic-like reaction who underwent a subsequent gadobutrol-enhanced magnetic resonance imaging after a standard 13-hour corticosteroid and antihistamine premedication protocol before repeat injection were identified. Patient characteristics, volume of gadobutrol injected, and severity of index and breakthrough reactions were recorded and compared by χ2 test, t test, and Spearman correlation.

Results The index allergic-like reaction rate to gadobutrol was 0.28% (69/25000). Of the patients who had an index allergic-like reaction, 45% (31/69) had a subsequent magnetic resonance imaging with gadobutrol injection and premedication with a breakthrough reaction rate of 35% (11/31). Most index reactions were mild in severity (91% [63/69]), and most breakthrough reactions were also typically mild (91% [10/11]). One patient escalated from a mild index reaction to a moderate breakthrough reaction despite premedication. There was no correlation between volume of gadobutrol injected (ρ = −0.004, P = 0.98) or association with age (P = 0.74), although female patients had higher breakthrough reaction rates (P = 0.007).

Conclusions Allergic-like reactions to gadobutrol are rare; however, breakthrough reactions occur with moderate frequency despite premedication, and although generally of mild severity, in our series, one breakthrough reaction escalated in severity.

From the Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.

Received for publication December 13, 2018; and accepted for publication, after revision, January 27, 2019.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Nicola Schieda, MD, FRCPC, Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, Ontario K1Y 4E9, Canada. E-mail:

Online date: March 18, 2019

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