From the Department of Radiology, Anjo Kosei Hospital, Anjo, Japan (H.U.); Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan (T.N.); Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan (A.T.); Department of Radiology, Komaki City Hospital, Komaki, Japan (N.H.); Department of Radiology, Nagoya University Hospital, Nagoya, Japan (S.I.); Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan (Y.T., S.N.); Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.); and Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukakecho, Toyoake 470-1192, Japan (T.T.).
Radiology. 2022 Nov;305(2):341-349. doi: 10.1148/radiol.220370. Epub 2022 Jul 19.
Background Changing iodinated contrast media (ICM) may reduce the risk of recurrent ICM-induced hypersensitivity reactions in patients with a prior reaction. Purpose To perform a systematic review on the effectiveness of ICM change in comparison with no change to prevent recurrent ICM immediate hypersensitivity reactions. Materials and methods Multiple data bases were searched without language restriction between January 1990 and August 2021 to identify comparative studies of any design that included patients with a prior ICM hypersensitivity reaction to low-osmolality ICM and re-exposure to intravascular ICM. The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, and random-effects meta-analysis. The primary outcome was the incidence of all-grade immediate recurrent hypersensitivity reactions. Secondary outcomes were the incidence of severe immediate recurrent hypersensitivity reactions and other adverse events associated with ICM change. Results Six retrospective observational studies at moderate to severe risk of bias assessed 7155 adult patients (4329 in the ICM change group and 2826 in the no-change group). Studies adopted nonstandardized switching methods, and the proportions of the ICM change group ranged between 19% (five of 27 examinations) and 80% (3104 of 3880 examinations). A Bayesian meta-analysis revealed that changing ICM was associated with a reduced risk of recurrent hypersensitivity reaction by 61% (risk ratio = 0.39; 95% credible interval [CrI]: 0.24, 0.58). The wide-ranging estimates of risk reduction were not explained by the risk of bias ratings, the event rates in the no-change group, the index-reaction severity, or the co-administered nonstandard premedication. Rare severe recurrent reactions (five studies with five events) precluded a conclusion (risk ratio = 0.34, favoring ICM change; CrI: 0.01, 3.74). Adverse events associated with ICM change were not reported. Conclusion In observational evidence of limited quality, iodinated contrast media (ICM)-change was associated with a reduced risk of recurrent immediate hypersensitivity reaction in patients with a prior ICM-induced hypersensitivity reaction. © RSNA, 2022 See also the editorial by McDonald in this issue.
改变含碘造影剂（ICM）可能会降低有既往反应的患者再次发生 ICM 诱导的即刻过敏反应的风险。目的：对改变 ICM 与不改变 ICM 以预防再次发生 ICM 即刻过敏反应的效果进行系统评价。材料与方法：无语言限制地在 1990 年 1 月至 2021 年 8 月间对多个数据库进行检索，以确定包含有既往对低渗性 ICM 发生即刻过敏反应且再次接受血管内 ICM 检查的患者的任何设计的比较研究。采用的方法包括对纳入标准进行重复评估、对定量数据进行双重提取、有效性评估和随机效应荟萃分析。主要结局是所有级别即刻复发过敏反应的发生率。次要结局是严重即刻复发过敏反应的发生率和与 ICM 改变相关的其他不良事件。结果：6 项回顾性观察性研究存在中至高度偏倚风险，共评估了 7155 例成年患者（ICM 改变组 4329 例，无改变组 2826 例）。研究采用了非标准化的转换方法，ICM 改变组的比例在 19%（27 次检查中的 5 次）至 80%（3880 次检查中的 3104 次）之间变化。贝叶斯荟萃分析显示，改变 ICM 可使复发过敏反应的风险降低 61%（风险比=0.39；95%可信区间：0.24，0.58）。降低风险的广泛估计值不能用偏倚风险评分、无改变组的事件发生率、指数反应严重程度或同时给予的非标准预用药来解释。罕见的严重复发反应（5 项研究共 5 个事件）无法得出结论（风险比=0.34，支持 ICM 改变；95%可信区间：0.01，3.74）。未报告与 ICM 改变相关的不良事件。结论：在质量有限的观察性证据中，改变含碘造影剂（ICM）与既往 ICM 诱导的过敏反应患者再次发生即刻过敏反应的风险降低相关。
