ACR updates guidance for managing and preventing contrast media reactions
The American College of Radiology has released updated recommendations related to the management and prevention of hypersensitivity reactions to iodinated contrast media (ICM).
Such reactions are rare, and the benefits of using ICM during imaging exams typically outweigh the possibility of negative side effects. Although the risks are minimal, there are rare cases when reactions can take a deadly turn.
The ACR provides a dedicated Contrast Manual to guide providers in pre- and post-scan decisions related to ICM. However, ACR’s guidance differs from that of other relevant organizations and the Anaphylaxis 2020 Practice Parameters Update. With the utilization of imaging continuing to climb, it is important for healthcare organizations to be on the same page with regard to how to manage the use of ICM.
“It remains imperative to provide guidance on the management of immediate and delayed reactions to ICM as well as the preparation, planning, and potential premedication for patients who have experienced adverse reactions,” Carolyn Wang, MD, with the Department of Radiology at the University of Washington in Seattle, and colleagues wrote in Radiology. “Patients labeled as having an ICM allergy in the medical record pose a multidisciplinary clinical problem requiring healthcare professionals to obtain a comprehensive history and to balance the potential risks of recurrent reactions with those of premedication and product avoidance, as appropriate.”
Recently, a group of experts from the American Academy of Allergy, Asthma & Immunology (AAAAI) and radiology physician representatives from the ACR Committee on Drugs and Contrast—all of whom have expertise in ICM—convened to examine the latest scientific evidence related hypersensitivity reactions. Together, they developed a set of consensus recommendations. While many are in line with those previously developed, a few changes have been made to ACR’s guidelines.
The new recommendations address discordance between organizations’ prior guidelines on the use of premedication.
Here are some of the highlights:
Premedication is no longer recommended for patients who have a history of mild immediate ICM hypersensitivity reactions. Instead, when feasible, ACR recommends changing the contrast agent when the ICM that caused the initial reaction is known.
For patients who have a history of severe immediate reactions, it is recommended that providers use alternative studies or modalities when feasible. If use of ICM is deemed necessary and the agent cannot be changed, premedication is recommended. These studies should also take place in a hospital where a rapid response team is available.
Premedication is not recommended for patients with a history of chemotoxic or physiologic reactions. It also is not necessary for those with an isolated history of shellfish or iodine allergies, including topical povidone-iodine.
The authors emphasized the importance of documenting details specific to patients’ reactions, including their symptoms, time of symptom onset, type and amount of contrast used. This ensures providers will have the best odds of managing potential reactions if patients require ICM during imaging.
More detailed information on the updates can be found in the journal Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.