From the Departments of Radiology (M.J.C., J.S.B.) and Internal Medicine (J.W.J.), Chung-Ang University Hospital, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, 101 Jongno-Gu Seoul, 110-744 Korea (D.Y.K., H.R.K.); Departments of Preventive Medicine (D.Y.K.), Radiology (W.L., S.H.Y., Y.H.C.), and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea (J.L.); Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (Y.H.K.); Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea (K.S.C.); Department of Radiology, Chung-Buk National University Hospital, Chungju, Korea (B.S.C.); Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea (K.N.J.); and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea (H.R.K.).
Radiology. 2019 Oct;293(1):117-124. doi: 10.1148/radiol.2019190485. Epub 2019 Sep 3.
Background Multicenter studies may be required for establishing guidelines for safe usage of iodinated contrast media (ICM). Purpose To identify the prevalence, patterns, risk factors, and preventive measures for ICM-related hypersensitivity reactions (HSRs). Materials and Methods Between March 2017 and October 2017, a total of 196 081 patients who underwent ICM administration were enrolled from seven participating institutions. The occurrence of HSRs and baseline patient information were recorded. χ and Student test were performed, and logistic regression analyses were used to identify risk factors that predict occurrence and recurrence of HSR. Results Among 196 081 patients (mean age ± standard deviation, 59.1 years ± 16.0; 105 014 men and 91 067 women) who underwent ICM administration, the overall prevalence of HSRs was 0.73% (1433 of 196 081), and severe reactions occurred in 0.01% (17 of 196 081). Conditional logistic regression for patients with HSR ( = 1433) and a control group (1:1 matched group for age, sex, ICM product, and institution) demonstrated that a patient's previous individual history of an ICM-related HSR (adjusted odds ratio [OR], 198.8; < .001), hyperthyroidism (adjusted OR, 3.6; = .04), drug allergy (adjusted OR, 3.5; < .001), and other allergic diseases (adjusted OR, 6.8; < .001) and a family history of ICM-related HSRs (adjusted OR, 14.0; = .01) were predictors of HSR occurrence. Logistic regression analysis showed that use of premedication with antihistamine (OR, 0.5; = .01) and change in the generic profile of ICM (OR, 0.5; < .001) were preventive against recurrent HSR. Conclusion Family history as well as previous individual history of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) were risk factors for HSR occurrence, suggesting a potential genetic predisposition. A change in the culprit ICM and premedication with antihistamine are useful for reducing the recurrence of HSRs. © RSNA, 2019
建立碘造影剂（ICM）安全使用指南可能需要进行多中心研究。目的：确定 ICM 相关过敏反应（HSR）的发生率、模式、危险因素和预防措施。材料与方法：2017 年 3 月至 2017 年 10 月，从 7 家参与机构共纳入 196081 例接受 ICM 给药的患者，记录 HSR 发生情况和患者基线资料。采用卡方检验和 Student 检验，采用 logistic 回归分析识别预测 HSR 发生和复发的危险因素。结果：在接受 ICM 给药的 196081 例患者（平均年龄±标准差，59.1 岁±16.0；105014 例男性和 91067 例女性）中，HSR 总发生率为 0.73%（1433 例/196081），严重反应发生率为 0.01%（17 例/196081）。对 HSR 患者（=1433 例）和对照组（年龄、性别、ICM 产品和机构 1:1 匹配组）行条件 logistic 回归分析显示，患者既往有 ICM 相关 HSR 个人史（调整后比值比[OR]，198.8；<.001）、甲状腺功能亢进症（调整后 OR，3.6；=.04）、药物过敏（调整后 OR，3.5；<.001）和其他过敏性疾病（调整后 OR，6.8；<.001）和 ICM 相关 HSR 家族史（调整后 OR，14.0；=.01）是 HSR 发生的预测因素。Logistic 回归分析显示，使用抗组胺药进行预处理（OR，0.5；=.01）和 ICM 通用类型改变（OR，0.5；<.001）是预防 HSR 复发的措施。结论：对碘造影剂（ICM）的家族史和个人过敏反应（HSR）既往史是 HSR 发生的危险因素，提示可能存在遗传易感性。改变可疑 ICM 并使用抗组胺药进行预处理有助于减少 HSR 复发。
