Acute Allergic-Like Reactions to Gadolinium-Containing IV Contrast Media
Acute Allergic-Like Reactions to Gadolinium-Containing IV Contrast Media
Objective: The purpose of our study was to determine the frequency and severity of acute allergic-like reactions to IV-administered gadolinium-containing contrast media in children and adults.
Materials and Methods: Pediatric (younger than 19 years) and adult department of radiology contrast material reaction forms involving patients who experienced acute allergic-like reactions to gadolinium-containing contrast media from January 1, 2001, through December 31, 2006, were retrospectively evaluated for the specific types of acute allergic-like reactions, reaction management, and patient outcomes. Relevant patient medical information, including documentation of prior gadolinium- or iodine-containing contrast material reaction, premedication before acute allergic-like reaction to IV gadolinium-containing contrast material, previous allergic reactions to substances other than contrast media, and history of asthma, was obtained by reviewing electronic medical records.
Results: Seventy-eight thousand three hundred fifty-three (65,009 adult and 13,344 pediatric) IV administrations of gadolinium-containing contrast material were performed during the study period. Acute allergic-like reactions were documented after 54 injections (reaction frequency, 0.07%). Forty-eight reactions involved adult patients (adult reaction frequency, 0.07%), and six reactions occurred in pediatric patients (pediatric reaction frequency, 0.04%). Forty (74%) acute allergic-like reactions were mild, 10 (19%) were moderate, and four (7%) were severe. No gadolinium-containing contrast material-related death occurred during the study period. Twenty-six (50%) of 52 patients had one or more presumed risk factors for contrast material reaction.
Conclusion: Adult and pediatric acute allergic-like reactions to IV-administered gadolinium-containing contrast media are rare. Most of these reactions are mild; however, moderate and severe reactions that require immediate management do occur.
The use of contrast-enhanced MRI has increased over the past decade as a variety of new applications have been described and put into clinical practice. Consequently, the number of annual pediatric and adult administrations of gadolinium-containing contrast agents has also increased considerably (65% from 2001 to 2006 at our institution). Although the IV administration of gadolinium-containing contrast media has been approved in some form for nearly two decades, it is essential that we continuously reevaluate the safety of these agents.
For many years, gadolinium-containing contrast materials have been considered quite safe, with minimal associated risk. This position may be changing somewhat, however, with the recent recognition of an association between gadolinium-containing contrast agents and nephrogenic systemic fibrosis (NSF). Allergic-like reactions are another risk, albeit rare, attributed to IV-administered gadolinium-containing contrast materials. The risk of allergic-like reaction to gadolinium-containing contrast agents has long been thought to be quite low, particularly when compared with iodinated contrast agents. Review of the literature reveals few recent large prospective or retrospective studies evaluating the frequency and severity of allergic-like contrast reactions to currently used gadolinium-containing contrast agents. This is particularly true for the pediatric patient population.
The purpose of this study was to determine the frequency and severity of acute allergic-like reactions to IV-administered gadolinium-containing contrast media in children and adults. In addition, we sought to determine the frequency with which patients who reacted possessed certain presumed risk factors for allergic-like contrast material reaction.
Abstract and Introduction
Abstract
Objective: The purpose of our study was to determine the frequency and severity of acute allergic-like reactions to IV-administered gadolinium-containing contrast media in children and adults.
Materials and Methods: Pediatric (younger than 19 years) and adult department of radiology contrast material reaction forms involving patients who experienced acute allergic-like reactions to gadolinium-containing contrast media from January 1, 2001, through December 31, 2006, were retrospectively evaluated for the specific types of acute allergic-like reactions, reaction management, and patient outcomes. Relevant patient medical information, including documentation of prior gadolinium- or iodine-containing contrast material reaction, premedication before acute allergic-like reaction to IV gadolinium-containing contrast material, previous allergic reactions to substances other than contrast media, and history of asthma, was obtained by reviewing electronic medical records.
Results: Seventy-eight thousand three hundred fifty-three (65,009 adult and 13,344 pediatric) IV administrations of gadolinium-containing contrast material were performed during the study period. Acute allergic-like reactions were documented after 54 injections (reaction frequency, 0.07%). Forty-eight reactions involved adult patients (adult reaction frequency, 0.07%), and six reactions occurred in pediatric patients (pediatric reaction frequency, 0.04%). Forty (74%) acute allergic-like reactions were mild, 10 (19%) were moderate, and four (7%) were severe. No gadolinium-containing contrast material-related death occurred during the study period. Twenty-six (50%) of 52 patients had one or more presumed risk factors for contrast material reaction.
Conclusion: Adult and pediatric acute allergic-like reactions to IV-administered gadolinium-containing contrast media are rare. Most of these reactions are mild; however, moderate and severe reactions that require immediate management do occur.
Introduction
The use of contrast-enhanced MRI has increased over the past decade as a variety of new applications have been described and put into clinical practice. Consequently, the number of annual pediatric and adult administrations of gadolinium-containing contrast agents has also increased considerably (65% from 2001 to 2006 at our institution). Although the IV administration of gadolinium-containing contrast media has been approved in some form for nearly two decades, it is essential that we continuously reevaluate the safety of these agents.
For many years, gadolinium-containing contrast materials have been considered quite safe, with minimal associated risk. This position may be changing somewhat, however, with the recent recognition of an association between gadolinium-containing contrast agents and nephrogenic systemic fibrosis (NSF). Allergic-like reactions are another risk, albeit rare, attributed to IV-administered gadolinium-containing contrast materials. The risk of allergic-like reaction to gadolinium-containing contrast agents has long been thought to be quite low, particularly when compared with iodinated contrast agents. Review of the literature reveals few recent large prospective or retrospective studies evaluating the frequency and severity of allergic-like contrast reactions to currently used gadolinium-containing contrast agents. This is particularly true for the pediatric patient population.
The purpose of this study was to determine the frequency and severity of acute allergic-like reactions to IV-administered gadolinium-containing contrast media in children and adults. In addition, we sought to determine the frequency with which patients who reacted possessed certain presumed risk factors for allergic-like contrast material reaction.