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Bruen R, Stirling A, Ryan M, et al. Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media. Emerg Radiol. 2021;doi: 10.1007/s10140-021-01989-0.
Bruen, R., Stirling, A., Ryan, M., Sheehan, M., & MacMahon, P. (2021). Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media. Emergency radiology, . https://doi.org/10.1007/s10140-021-01989-0
Bruen, Richard, et al. "Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media." Emergency radiology vol. (2021). doi: https://doi.org/10.1007/s10140-021-01989-0
Bruen R, Stirling A, Ryan M, Sheehan M, MacMahon P. Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media. Emerg Radiol. 2021 Oct 05; doi: 10.1007/s10140-021-01989-0. Epub 2021 Oct 05. PMID: 34609674.
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Emerg Radiol. 2021 Oct 05; doi: 10.1007/s10140-021-01989-0. Epub 2021 Oct 05.

Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media.

Emergency radiology

Richard Bruen, Aaron Stirling, M Ryan, M Sheehan, Peter MacMahon

Affiliations

  1. University of Limerick, Limerick, Ireland. [email protected].
  2. Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
  3. Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland.
  4. School of Medicine, University College Dublin, Dublin, Ireland.

PMID: 34609674 DOI: 10.1007/s10140-021-01989-0

Abstract

PURPOSE: In excess of 100 million procedures using iodinated radio-contrast media are conducted each year. There is a common misunderstanding regarding the links between allergy to iodinated substances and the risk of allergic reaction to intravenous iodinated contrast agents. These perceived risks are managed via administration of corticosteroids or avoidance of iodinated contrast altogether.

METHODS: An extensive review of published literature on scientific databases and international guidelines was conducted in order to inform the research question. A questionnaire was formulated and distributed to hospital doctors in four tertiary centres. Within this questionnaire, hospital doctors were presented with six different scenarios of bona fide allergy to iodinated substances (e.g. shellfish) and asked to select the treatment response option which they deemed to be the most suitable from a choice of three (standard contrast scan/delay scan with pre-medication/change to non-contrast scan).

RESULTS: Eighty-seven questionnaire responses were received. Contrast (standard protocol) was the most appropriate regimen in the setting of all the listed allergies. This was identified correctly by 76%, 69%, 44%, 32%, 18% and 14% for kiwi, fish, poly-food, shellfish, betadine and tincture of iodine allergies, respectively.

CONCLUSIONS: There is a lack of understanding amongst local junior medical staff regarding administration of iodinated contrast media to patients with a history of allergy to iodinated substances. These misconceptions may potentiate the unnecessary usage of pre-medication and ordering of non-contrast scans in the setting of a gold-standard enhanced scan. Findings from this study suggest that there is a need for future education efforts targeted during the basic specialty training stage.

© 2021. American Society of Emergency Radiology.

Keywords: Allergy; Contrast-enhanced scans; Iodinated contrast media; Radiology; Shellfish; Shellfish allergy

References

  1. Böhm I, Morelli J, Nairz K, Silva Hasembank Keller P, Heverhagen JT (2017) Myths and misconceptions concerning contrast media-induced anaphylaxis: a narrative review. Postgrad Med 129(2):259–266. https://doi.org/10.1080/00325481.2017.1282296 - PubMed
  2. Pradubpongsa P, Dhana N, Jongjarearnprasert K, Janpanich S, Thongnharm T (2013) Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome-the results of a 3-year period. Asian Pac J Allergy Immunol 31:299–306 - PubMed
  3. Baig M, Farag A, Sajid J, Potluri R, Irwin RB, Khalid HM (2014) Shellfish allergy and relation to iodinated contrast media: United Kingdom survey. World J Cardiol 6:107–111 - PubMed
  4. Dewatcher P, Mouton-Faivre C (2015) Allergy to iodinated drugs and to foods rich in iodine: iodine is not the allergenic determinant. Presse Med 44:1136–1145 - PubMed
  5. Beaty A, Liebermann P, Slavin R (2008) Seafood allergy and radiocontrast media: are physicians propagating a myth? Am J Med 121(158):e1-4 - PubMed
  6. Sampson CS, Goddard KB, Starr-Mar’ee CB, Stilley JA (2019) The “myth” of iodine allergy to radiocontrast in Emergency Medicine. Am J Emerg Med 37(7):1363–1365 - PubMed
  7. Westermann-Clark E, Pepper AN, Talreja N, Lockey RF (2015) Debunking myths about “allergy” to radiocontrast media in an academic institution. Postgrad Med 127:295–300 - PubMed
  8. Macy E (2018) Current epidemiology and management of radiocontrast-associated acute- and delayed-onset hypersensitivity: a review of the literature. Perm J 22:17–072 - PubMed
  9. Dickinson M, Kam P (2008) Intravascular iodinated contrast media and the anaesthetist. Anaesthesia 63:626–634 - PubMed
  10. Sanchez-Borges M, Aberer W, Brockow K, Celik GE, Cernadas J, Greenberger P, Masse MS, Schijvers R, Trautmann A (2019) Controversies in drug allergy: radiographic contrast media. J Allergy Clin Immunol Pract 7:61–65 - PubMed
  11. Schopp J, Iyer R, Wang C, Petscavage J, Paladin A, Bush W, Dighe M (2013) Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol 20:299–306 - PubMed
  12. Pasternak J, Williamson E (2012) Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist. Mayo Clin Proc 87:390–402 - PubMed
  13. Morcos S (2005) Review article: acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol 78:686–693 - PubMed
  14. American College of Radiology Manual on Contrast Media. http://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast-Media.pdf . Accessed 12 Sept 2021 - PubMed
  15. Katelaris C, Smith WB (2009) ‘Iodine allergy’ label is misleading. Aust Prescr 32:125–128 - PubMed
  16. Schabelman E, Witting M (2010) The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. J Emerg Med 39:701–707 - PubMed
  17. Callahan M, Servaes S, Lee EY, Towbin A, WestraE SJ, Frush DP (2014) Practice patterns for the use of iodinated i.v. contrast media for pediatric CT studies: a survey of the Society for Pediatric Radiology. AJR Am J Roentgenol 202:872–879 - PubMed
  18. Park H, Park J, Yang M, Kim M, Kim S, Jang G, Nam Y, Kim G, Kim S, Park H, Jung J, Park J, Kang H (2017) Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: a multicentre retrospective cohort study. Eur Radiol 27:2886–2893 - PubMed
  19. Davenport M, Cohan R, Caoili E, Ellis J (2009) Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology 253:372–379 - PubMed
  20. Knuth T, Paxton J, Myers D (2011) Intraosseous injection of iodinated computed tomography contrast agent in an adult blunt trauma patient. Ann Emerg Med 57(4):382–386 - PubMed
  21. Cournane S, Conway R, Creagh D, Byrne DG, Sheehy N, Silke B (2016) Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions. Clin Radiol 71:912–918 - PubMed
  22. Griffin E, Herlihy D, Hayden R, Murphy M, Walsh J, Murphy S, Shanahan J, O’Brien P, Power S, Brennan P, Motyer R, Thornton J (2019) A quantitative analysis of CT angiography, large vessel occlusion, and thrombectomy rates in acute ischaemic stroke. Clin Radiol 74(9):e21-731 - PubMed
  23. Hamshere S, Pfeffer P, Ali R (2011) Shellfish allergy and contrast media. J Allergy Clin Immunol 127(2):AB192 - PubMed
  24. Mammarappallil JG, Hiatt KD, Vincent W, Bettmann MA (2016) How accurate is the label “allergic to iodinated contrast agents”? Acta radiologica (Stockholm, Sweden : 1987) 57(1):47–50. https://doi.org/10.1177/0284185114568049 - PubMed
  25. Shehadi WH (1975) Adverse reactions to intravascularly administered contrast media. A comprehensive study based on a prospective survey. Am J Roentgenol Radium Ther Nucl Med 124:145–152 - PubMed

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