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/s00330-025-11675-1.
Hypersensitivity reactions to iodine-based, gadolinium-based and ultrasound contrast agents are a heterogeneous group that occur infrequently and can be classified as either immediate or non-immediate. In imaging, most are mild or moderate, while severe reactions are very rare. A standardized risk assessment and close patient monitoring are crucial. In addition to liberal use of supportive treatment by oxygen and volume expansion, the main drugs for treatment of individual reactions include intramuscular adrenaline and H1-antihistamines, with limited indications for short-acting β2-agonists (SABA) like salbutamol or albuterol. As these reactions occur infrequently, these situations often create stress and confusion. During treatment, the stability or progression of the reaction should be constantly assessed, assigning a specific task to each team member. In addition, detailed documentation and correct classification of the severity of such reactions will help improve the risk management in future imaging studies. Regular hands-on training for all personnel involved in managing these reactions is mandatory. To help, the ESUR Contrast Media Safety Committee has reviewed the literature on hypersensitivity reactions and updated its guidance on how to appropriately manage, treat, and document immediate and non-immediate hypersensitivity reactions to contrast media in adults. KEY POINTS: Question Hypersensitivity reactions to contrast media may require immediate action to prevent further damage to the patient. Guidance on management would help improving preparedness. Findings Clear treatment protocols with cards or flowcharts are mandatory. Intramuscular adrenaline is the most important drug for treatment. Documentation should be agent-specific and standardized. Clinical relevance The ESUR Contrast Media Safety Committee has updated its guidance on how to appropriately manage, treat, and document immediate and non-immediate hypersensitivity reactions to contrast media in adults.
对碘基、钆基和超声造影剂的过敏反应是一组异质性反应，发生率较低，可分为速发型或非速发型。在影像学检查中，大多数反应为轻度或中度，严重反应非常罕见。标准化的风险评估和密切的患者监测至关重要。除了大量使用氧气支持治疗和扩容治疗外，治疗个别反应的主要药物包括肌内注射肾上腺素和H1抗组胺药，沙丁胺醇或异丙肾上腺素等短效β2激动剂（SABA）的适应证有限。由于这些反应很少发生，这些情况常常会造成压力和混乱。治疗期间，应持续评估反应的稳定性或进展情况，为每个团队成员分配特定任务。此外，对此类反应的严重程度进行详细记录和正确分类，将有助于改善未来影像学检查中的风险管理。对所有参与处理这些反应的人员进行定期实践培训是必不可少的。为提供帮助，欧洲放射学会造影剂安全委员会回顾了关于过敏反应的文献，并更新了其关于如何适当管理、治疗和记录成人对比剂速发型和非速发型过敏反应的指南。要点：问题对比剂过敏反应可能需要立即采取行动，以防止对患者造成进一步损害。管理指南将有助于提高准备水平。研究结果必须有清晰的治疗方案卡片或流程图。肌内注射肾上腺素是最重要的治疗药物。记录应针对特定造影剂并标准化。临床意义欧洲放射学会造影剂安全委员会更新了其关于如何适当管理、治疗和记录成人对比剂速发型和非速发型过敏反应的指南。
