Abstract
Background: Radiocontrast agents are some of the most commonly used medications in
the emergency department. However, both physicians and patients misunderstand the
role that allergies play in reactions to radiocontrast media, especially with regards
to shellfish and iodine. Objectives: We sought to review the literature describing
rates of contrast reactions and risk of contrast administration to patients with iodine
allergy, shellfish or seafood allergies, or prior reactions to intravenous iodinated
contrast. Method: Both authors independently performed literature reviews, including
position statements of stakeholder organizations, to gain perspective on important
issues. They subsequently performed a systematic search for articles that estimated
the risk of administration of iodinated contrast to those with a prior history of
contrast reaction, “iodine allergy,” or reaction to seafood or shellfish. Results:
The risk of reactions to contrast ranges from 0.2–17%, depending on the type of contrast
used, the severity of reaction considered, and the prior history of any allergy. The
risk of reaction in patients with a seafood allergy is similar to that in patients
with other food allergies or asthma. A history of prior reaction to contrast increases
the risk of mild reactions to as high as 7–17%, but has not been shown to increase
the rate of severe reactions. Severe reactions occur in 0.02–0.5% and deaths in 0.0006–0.006%;
neither have been related to “iodine allergy,” seafood allergy, or prior contrast
reaction. Low-osmolality contrast media became available in 1988, and many of the
higher risk estimates were from the era before it was widely available. Conclusions:
Iodine is not an allergen. Atopy, in general, confers an increased risk of reaction
to contrast administration, but the risk of contrast administration is low, even in
patients with a history of “iodine allergy,” seafood allergy, or prior contrast reaction.
Allergies to shellfish, in particular, do not increase the risk of reaction to intravenous
contrast any more that of other allergies.
Keywords
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Article info
Publication history
Published online: January 04, 2010
Accepted:
October 19,
2009
Received in revised form:
September 30,
2009
Received:
January 21,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
