From the Department of Radiology, Seoul National University Hospital.
Department of Radiology, Seoul National University College of Medicine.
Invest Radiol. 2019 Oct;54(10):633-637. doi: 10.1097/RLI.0000000000000573.
Currently, the prevention of recurrent immediate hypersensitivity reactions (HSRs) to contrast media (CM) requests premedication and changing the culprit contrast agent. However, strategies for the prevention of immediate HSRs to gadolinium-based magnetic resonance contrast agents (GBCAs) have not yet been established. This study aimed to evaluate the effectiveness of changing the contrast agent and single-dose premedication for HSR recurrence prevention in patients with a history of mild immediate HSR to GBCA.
The outcomes of patients with mild immediate HSR to GBCA who subsequently underwent enhanced magnetic resonance imaging between October 2012 and July 2017 were analyzed. The institutional CM monitoring system was retrospectively reviewed, and data on the application of premedication and choice of CM were obtained. Gadolinium-based magnetic resonance contrast agents were classified into 3 classes according to their molecular structure (macrocyclic ionic, macrocyclic nonionic, and linear ionic). Intravenous chlorpheniramine 4 mg, 30 minutes before the GBCA administration, or intravenous methylprednisolone sodium succinate 40 mg plus chlorpheniramine 4 mg, 1 hour before the GBCA administration, was administrated as premedication regimen. Recurrence rates of immediate HSR were compared according to prevention strategies.
A total of 185 patients with a history of mild immediate HSR to GBCA were re-exposed to GBCA 397 times during the study period. The overall recurrence rate was 19.6% (78/397). Changing the culprit GBCA significantly reduced the recurrence rate, compared with reusing the culprit GBCA (6.9%, 9/130 and 25.8%, 69/267; P < 0.001). The recurrence rate was lowest when the GBCA was changed to a different molecular structure class from the culprit agent, followed by changing to CM with the same molecular structure and reusing the culprit GBCA (6.2%, 7/113 vs 11.8%, 2/17 vs 25.8%, 69/267; P < 0.001 with χ test for trend). Single-dose premedication demonstrated no significant prophylactic effect on recurrence (20.4%, 17/98 vs 17.3%, 61/299 with and without premedication, respectively; P = 0.509). Premedication in addition to changing CM also showed no additional prophylactic effect (7.2%, 7/97 and 6.1%, 2/33, respectively; P = 0.821).
Changing the CM from the culprit agent could reduce the chance of HSR recurrence in patients with prior mild immediate HSR to GBCA, especially when the CM was changed to one of a different molecular structure class. However, single-dose premedication administration did not show significant HSR recurrence rate difference.
目前，预防对比剂（CM）再次引起的即刻过敏反应（HSR）的策略包括预先用药和更换致敏性对比剂。然而，尚未建立预防钆基磁共振对比剂（GBCA）引起即刻 HSR 的策略。本研究旨在评估在有 GBCA 轻度即刻 HSR 病史的患者中，更换对比剂和单次剂量预用药对预防 HSR 复发的效果。
分析了 2012 年 10 月至 2017 年 7 月间因轻度即刻 GBCA HSR 而随后行增强磁共振成像的患者的结局。回顾性分析机构的 CM 监测系统，并获得预用药和 CM 选择的数据。根据分子结构（大环离子型、大环非离子型和线性离子型）将 GBCA 分为 3 类。在 GBCA 给药前 30 分钟静脉给予氯苯那敏 4mg，或在 GBCA 给药前 1 小时给予甲泼尼龙琥珀酸钠 40mg 加氯苯那敏 4mg 作为预用药方案。根据预防策略比较即刻 HSR 复发率。
共有 185 例有 GBCA 轻度即刻 HSR 病史的患者在研究期间再次暴露于 GBCA 397 次。总体复发率为 19.6%（78/397）。与再次使用致敏性 GBCA 相比，更换致敏性 GBCA 显著降低了复发率（分别为 6.9%，9/130 和 25.8%，69/267；P<0.001）。从致敏性 GBCA 更换为不同分子结构类别的 GBCA 的复发率最低，其次是更换为相同分子结构的 CM 和再次使用致敏性 GBCA（分别为 6.2%，7/113 比 11.8%，2/17 比 25.8%，69/267；趋势检验的 P<0.001）。单次剂量预用药对复发无明显预防作用（分别为 20.4%，17/98 和 17.3%，61/299；P=0.509）。CM 与预用药联合更换也没有额外的预防作用（分别为 7.2%，7/97 和 6.1%，2/33；P=0.821）。
在有 GBCA 轻度即刻 HSR 病史的患者中，更换致敏性 GBCA 可降低 HSR 复发的机会，尤其是更换为不同分子结构类别的 GBCA 时。然而，单次剂量预用药并未显示出显著的 HSR 复发率差异。
