Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement From the American College of Radiology and the AAAAI

Carolyn Wang; Allison Ramsey; David Lang; Ana Maria Copaescu; Pranay Krishnan; Merin Kuruvilla; Benjamin Mervak; Jeffrey Newhouse; Alisa Sumkin; Rebecca Saff

doi:10.1016/j.jaip.2025.01.042

Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement From the American College of Radiology and the AAAAI

J Allergy Clin Immunol Pract. 2025 Mar 10:S2213-2198(25)00191-6. doi: 10.1016/j.jaip.2025.01.042. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, University of Washington, Seattle, Wash. Electronic address: wangcl@uw.edu.
² Division of Allergy/Immunology and Rheumatology, Rochester Regional Health, Division of Allergy/Immunology, University of Rochester, Rochester, NY. Electronic address: allison.ramsey@rochesterregional.org.
³ Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio; Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio.
⁴ Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Research Institute of McGill University Health Centre, McGill University, McGill University Health Centre, Montreal, Quebec, Canada.
⁵ Department of Clinical Radiology, MedStar Georgetown University Hospital, Washington, DC.
⁶ Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory University School of Medicine, Atlanta, Ga.
⁷ Department of Radiology, Michigan Medicine, Ann Arbor, Mich.
⁸ Department of Radiology and Urology, Columbia University Irving Medical Center, New York, NY.
⁹ RadNet, Los Angeles, Calif.
¹⁰ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.

PMID: 40332064
DOI: 10.1016/j.jaip.2025.01.042

Abstract

Intravenous iodinated contrast media (ICM) is widely used in the United States, and it is imperative to provide guidance on the management of adverse reactions to ICM as well as the preparation, planning, and potential premedication for patients with previous reactions. Currently there is a discordance between the American College of Radiology Contrast Manual, which recommends premedication to prevent repeat hypersensitivity reactions to ICM, and the Anaphylaxis 2020 Practice Parameters Update, which recommends against routine administration of glucocorticoids and/or antihistamines to prevent anaphylaxis with prior ICM hypersensitivity reactions. A task force of experts from radiology who are also members of the American College of Radiology Committee on Drugs and Contrast Media and expert allergists/immunologists including members of the Adverse Reactions to Drugs, Biologics and Latex Committee of American Academy of Allergy, Asthma & Immunology evaluated the scientific evidence to develop consensus recommendations that are endorsed by both organizations. The task force took into account the strength of evidence and balanced the potential risks of recurrent reactions with those of premedication and product avoidance when making these recommendations to improve and standardize the care of patients who experience or have a history of reaction to ICM.

Keywords: Anaphylaxis; Contrast allergy; Contrast hypersensitivity; Contrast reaction; Contrast skin testing; Contrast switching; Delayed contrast reaction; Immediate contrast reaction; Iodinated contrast allergy; Iodinated contrast hypersensitivity.

Publication types

Review