Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study

Hye Jung Park, Jung Won Park, Min Suk Yang, Mi Yeong Kim, Sae Hoon Kim, Gwang Cheon Jang, Young Hee Nam, Gun Woo Kim, Sujeong Kim, Hye Kyung Park, Jae Woo Jung, Jong Sook Park, Hye Ryun Kang

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objectives: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). Methods: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. Results: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. Conclusion: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. Key points: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.

Original languageEnglish
Pages (from-to)2886-2893
Number of pages8
JournalEuropean Radiology
Volume27
Issue number7
DOIs
Publication statusPublished - 2017 Jul 1

Fingerprint

Contrast Media
Hypersensitivity
Cohort Studies
Retrospective Studies
Premedication
Recurrence
Drug Hypersensitivity
Urticaria
Steroids
Multivariate Analysis
Odds Ratio
Tomography

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Park, Hye Jung ; Park, Jung Won ; Yang, Min Suk ; Kim, Mi Yeong ; Kim, Sae Hoon ; Jang, Gwang Cheon ; Nam, Young Hee ; Kim, Gun Woo ; Kim, Sujeong ; Park, Hye Kyung ; Jung, Jae Woo ; Park, Jong Sook ; Kang, Hye Ryun. / Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions : A multicentre retrospective cohort study. In: European Radiology. 2017 ; Vol. 27, No. 7. pp. 2886-2893.
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title = "Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study",
abstract = "Objectives: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). Methods: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. Results: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5{\%}. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1{\%} lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. Conclusion: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. Key points: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.",
author = "Park, {Hye Jung} and Park, {Jung Won} and Yang, {Min Suk} and Kim, {Mi Yeong} and Kim, {Sae Hoon} and Jang, {Gwang Cheon} and Nam, {Young Hee} and Kim, {Gun Woo} and Sujeong Kim and Park, {Hye Kyung} and Jung, {Jae Woo} and Park, {Jong Sook} and Kang, {Hye Ryun}",
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doi = "10.1007/s00330-016-4682-y",
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Park, HJ, Park, JW, Yang, MS, Kim, MY, Kim, SH, Jang, GC, Nam, YH, Kim, GW, Kim, S, Park, HK, Jung, JW, Park, JS & Kang, HR 2017, 'Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study', European Radiology, vol. 27, no. 7, pp. 2886-2893. https://doi.org/10.1007/s00330-016-4682-y

Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions : A multicentre retrospective cohort study. / Park, Hye Jung; Park, Jung Won; Yang, Min Suk; Kim, Mi Yeong; Kim, Sae Hoon; Jang, Gwang Cheon; Nam, Young Hee; Kim, Gun Woo; Kim, Sujeong; Park, Hye Kyung; Jung, Jae Woo; Park, Jong Sook; Kang, Hye Ryun.

In: European Radiology, Vol. 27, No. 7, 01.07.2017, p. 2886-2893.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions

T2 - A multicentre retrospective cohort study

AU - Park, Hye Jung

AU - Park, Jung Won

AU - Yang, Min Suk

AU - Kim, Mi Yeong

AU - Kim, Sae Hoon

AU - Jang, Gwang Cheon

AU - Nam, Young Hee

AU - Kim, Gun Woo

AU - Kim, Sujeong

AU - Park, Hye Kyung

AU - Jung, Jae Woo

AU - Park, Jong Sook

AU - Kang, Hye Ryun

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objectives: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). Methods: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. Results: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. Conclusion: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. Key points: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.

AB - Objectives: To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). Methods: We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. Results: A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. Conclusion: In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. Key points: • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.

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