van der Molen Aart J, van de Ven Annick A J M, Vega Francisco, Dekkers Ilona A, Geenen Remy W F, Bellin Marie-France, Bertolotto Michele, Brismar Torkel B, Clément Olivier, Correas Jean-Michel, Deike Katerina, Heinz Gertraud, Mahnken Andreas H, Mallio Carlo A, Quattrocchi Carlo C, Radbruch Alexander, Reimer Peter, Roditi Giles, Romanini Laura, Sebastià Carmen, Stacul Fulvio
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Division of Allergology, University Medical Center Groningen, Groningen, The Netherlands.
Eur Radiol. 2025 May 27. doi: 10.1007/s00330-025-11676-0.
Hypersensitivity reactions to contrast media are infrequent and can occur either within the first 60 min following their intravascular administration (immediate reactions) or at a later time point (non-immediate reactions). Most hypersensitivity reactions are mild or moderate, while severe reactions are rare (less than 1 in every 10,000 administrations). After any moderate or severe immediate adverse reaction, serum tryptase must be measured within 1-4 h from the onset of symptoms and at least 24 h after symptoms have disappeared to confirm a hypersensitivity reaction. At least for all moderate-to-severe hypersensitivity reactions, the patient should be referred to a drug allergy specialist for an allergy evaluation with a panel of contrast media, and optionally, all hypersensitivity reactions when local drug allergy specialist capacity allows. Selecting an alternative contrast medium based on practical experience is challenging due to its high and variable cross-reactivity; therefore, the best option is to choose an alternative based on the results of an allergy evaluation. This approach is safer and more effective than premedication for preventing recurrent hypersensitivity reactions. KEY POINTS: Question What is the optimal strategy in clinical practice to prevent recurrent hypersensitivity reactions in adults who previously experienced a hypersensitivity reaction to contrast media? Findings Serum tryptase should be measured within 1-4 h after a moderate or severe reaction, and at least all moderate or severe hypersensitivity reactions should be referred to an allergologist. Clinical relevance Management strategies should be adapted to the type and severity of the reaction, as well as the urgency of required re-administration. Changing from the culprit contrast agent to another molecule with differing side-chains is more effective than premedication.
对比剂的过敏反应并不常见，可在血管内注射后的头60分钟内发生（速发型反应），也可在稍后时间点出现（迟发型反应）。大多数过敏反应为轻度或中度，严重反应罕见（每10000次注射中少于1例）。发生任何中度或严重的速发型不良反应后，必须在症状出现后1 - 4小时内以及症状消失后至少24小时测量血清类胰蛋白酶，以确认过敏反应。至少对于所有中重度过敏反应，应将患者转诊至药物过敏专科医生处，进行对比剂组的过敏评估，如有条件，当地药物过敏专科医生有能力时，所有过敏反应都应进行评估。基于实际经验选择替代对比剂具有挑战性，因为其交叉反应性高且多变；因此，最佳选择是根据过敏评估结果来选择替代剂。这种方法在预防复发性过敏反应方面比预处理更安全、更有效。要点：问题在临床实践中，对于既往有对比剂过敏反应的成人，预防复发性过敏反应的最佳策略是什么？研究结果中度或重度反应后1 - 4小时内应测量血清类胰蛋白酶，至少所有中度或重度过敏反应都应转诊至过敏症专科医生处。临床意义管理策略应根据反应的类型和严重程度以及再次给药的紧迫性进行调整。从引起反应的对比剂更换为具有不同侧链的另一种分子比预处理更有效。
