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Late adverse reactions to intravascular iodine based contrast media: an update

  • Contrast Media
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Abstract

Definition

Late adverse reactions (LAR) to contrast media (CM) are defined as reactions occurring 1 h to 1 week after exposure.

Need for review

In view of more prospective studies of LAR and new data about their pathophysiology, the Contrast Medium Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) reviewed the literature on LAR and updated their guidelines.

Clinical features and pathology

LAR after CM include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. Skin reactions are well-documented LAR to CM with an incidence of approximately 2%–4% after nonionic monomers. LAR are commoner by a factor of three to four after nonionic dimers. The commonest skin reactions are maculopapular rashes, erythema and skin swelling. These reactions are T cell-mediated immune reactions, and the diagnosis may be confirmed using skin tests (patch or delayed reading intradermal). The main risk factors for LAR are a previous reaction to contrast medium, a history of allergy, and interleukin-2 treatment. Most skin reactions are mild or moderate and self-limiting.

Management

Management is symptomatic and similar to the management of other drug-induced skin reactions. To reduce the risk of repeat reactions avoidance of the relevant CM and any cross-reacting agents identified by skin testing is recommended.

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Author information

Authors and Affiliations

  1. Service de Radiologie Générale Adultes, Hôpital de Bicêtre, Secteur Paul Broca, 78, rue du Générale Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France

    Marie-France Bellin

  2. S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, 34134, Tieste, Italy

    Fulvio Stacul

  3. Department of Radiology, St. Bartholomew’s Hospital, University of London, West Smithfield, EC1A 7BE, London, United Kingdom

    Judith A. W. Webb

  4. Department of Diagnostic Sciences, Faculty of Health Sciences, University of Copenhagen, Herlev, Denmark

    Henrik S. Thomsen

  5. Department of Diagnostic Imaging, Northern General Hospital, Herries Road, S5 7AU, Sheffield, United Kingdom

    Sameh K. Morcos

  6. Lybska Vägen 10, 239 40, Falsterbo, Sweden

    Torsten Almén

  7. Department of Radiology, Karolinska Universitets sjukhus, Huddinge, 141 86, Huddinge, Sweden

    Peter Aspelin

  8. Service de Radiologie, Höpital Européen Georges Pompidou, 20 ru LeBlanc, 75015, Paris, France

    Olivier Clement

  9. Department of Radiology, University Hospital Vienna, AKH, Wahringer Gurtel 18-20, Vienna, 1090, Austria

    Gertraud Heinz-Peer

  10. Radiology, Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Molkestreet 90, 76133, Karlsruhe, Germany

    Peter Reimer

  11. Department of Radiology -C2-S, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, Holland

    Aart van der Molen

  12. Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark

    Henrik S. Thomsen

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  1. Marie-France Bellin
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  2. Fulvio Stacul
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  5. Sameh K. Morcos
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  6. Torsten Almén
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  7. Peter Aspelin
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  8. Olivier Clement
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on behalf of the Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR)

Corresponding author

Correspondence to Henrik S. Thomsen.

Additional information

Members of the Committee: H.S. Thomsen (Chairman, Denmark), S.K. Morcos (Secretary, United Kingdom), T. Almén (Sweden), P. Aspelin (Sweden), M.F. Bellin (France), O. Clement (France), G. Heinz-Peer (Austria), P. Reimer (Germany), F. Stacul (Italy), A.J. van der Molen (the Netherlands), J.A.W. Webb (United Kingdom). Consultants to the committee: J-M Idée (Guerbet, France), P. Lengsfeld (Bayer Schering Pharma, Germany), A. Spinazzi (Bracco, Italy), ESUR: www.esur.org

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Bellin, MF., Stacul, F., Webb, J.A.W. et al. Late adverse reactions to intravascular iodine based contrast media: an update. Eur Radiol 21, 2305–2310 (2011). https://doi.org/10.1007/s00330-011-2200-9

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  • DOI: https://doi.org/10.1007/s00330-011-2200-9

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