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J Korean Med Assoc > Volume 63(3); 2020 > Article
Cha and Lee: Change of culprit agent prevents recurrent hypersensitivity reactions to iodinated contrast media


With technical advances in computed tomography and the introduction of non-ionic low- or iso-osmolar iodinated contrast media (ICM), the use of ICM and the occurrence of ICM-related hypersensitivity reactions (HSRs) has rapidly increased. Although ICM-related HSRs are known to be mild, they still represent life-threatening events in rare instances. It is therefore important to prevent recurrent HSRs in high-risk patients. Changing the culprit contrast agent is a powerful known tool for reducing the recurrence rate of HSRs. Based on the large body of evidence, the American College of Radiology manual on contrast media (latest version 10.3) suggests that changing the ICM within the same class may help reduce the likelihood of a subsequent contrast reaction. Furthermore, the European Society of Urogenital Radiology guidelines on contrast agents (latest version 10) also recommends using a different contrast agent with previous contrast agent reactors to reduce the risk of an acute reaction. In this article, we review the necessity and clinical efficacy of changing the culprit ICM for high-risk patients at the time of re-exposure to prevent ICM-related HSRs and minimize the risk of fatality.

Figure 1.
Recurrence rates of hypersensitivity reactions (HSRs) according to iodinated contrast medium (ICM) changes and steroid premedication in the total patients (A), in patients with a moderate initial HSR (B). and in patients with a severe initial HSR (C). Reproduced from Park HJ et al. Eur Radiol 2017;27:2886-2893, with permission from Springer Nature [11].
Table 1.
Recurrence rates of iodinated contrast media-related hypersensitivity reaction according to the combination of contrast media in absence of premedication
Combination of contrast media Recurrence Odds ratio a) 95% confidence interval P-value Odds ratio b) 95% confidence interval P-value
Iopamidol/iopromide 24/110 (21.8) 0.470 0.247-0.892 0.021 1.863 0.995-3.487 0.052
Iopamidol/iopromide 11/58 (19.0) 0.366 0.163-0.820 0.015 1.466 0.654-3.289 0.353
Iohexol/iopromide 37/268 (13.8) 0.402 0.227-0.712 0.002 1.353 0.788-2.321 0.273
Iobitridol/iohexol 32/261 (12.3) 0.245 0.127-0.474 <0.001 0.877 0.468-1.680 0.713
Iobitridol/iopromide 18/169 (10.7) 0.296 0.129-0.682 0.001 1.048 0.462-2.374 0.911
Iobitridol/iopamidol 7/17 (41.2) 0.942 0.340-2.608 0.909 4.175 1.545-11.281 0.005
Iobitridol/ioversol 7/21 (33.3) 0.890 0.321-2.466 0.823 3.310 1.210-9.056 0.020
Iopromide/ioversol 1/2 (50.0) 1.344 0.083-21.898 0.835 5.961 0.369-96.259 0.208
Iohexol/ioversol 5/12 (41.7) 0.876 0.237-3.232 0.842 3.585 0.978-13.137 0.054
Iohexol/iomeprol 3/13 (23.1) 0.709 0.163-3.084 0.647 1.937 0.437-8.591 0.384
Iomeprol/iopamidol 4/19 (21.1) 0.472 0.144-1.551 0.216 1.804 0.551-5.913 0.330
Iopamidol/ioversol 2/10 (20.0) 0.188 0.023-1.569 0.123 0.779 0.094-6.454 0.817
Iomeprol/iopromide 2/11 (18.2) 0.612 0.108-3.451 0.578 1.877 0.321-10.980 0.485
Iobitridol/iomeprol 0/8 (0) NA NA NA NA NA NA
Iomeprol/ioversol 0/1 (0) NA NA NA NA NA NA

Except where indicated, data are the numerator/denominator of patients, with percentages in parentheses. Reproduced from Park SJ et al. Radiology 2018;288:710-716, with permission from the Radiological Society of North America [13]. NA, not assessable.

a) Compared with exposure to same contrast media.

b) Compared with exposure to different contrast media.


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