The American College of Radiology updated guidelines on intravenous iodinated construct media use and management of adverse reactions.
ICM is widely used in the U.S.. However, there was a lack of clarity between the American College of Radiology Contrast Manual and the Anaphylaxis 2020 Practice Parameters Update for how to manage and prevent adverse reactions to the contract. Experts from the American College of Radiology Committee on Drugs and Contrast Media and Adverse Reactions to Drugs, Biologics and Latex Committee of American Academy of Allergy, Asthma & Immunology worked together to evaluate the evidence and develop consensus recommendations.
Here are four key takeaways:
1. The groups recommend documenting hypersensitivity reactions, symptoms and specific inciting agents into the electronic medical record to help optimize future ICM reaction management.
2. Patients with a history of mild immediate ICM hypersensitivity reactions are not recommended to be on premedication. Instead, it is recommended to switch the contrast agent when feasible.
3. Patients with a history of severe immediate ICM hypersensitivity reactions should first consider alternative imaging studies. If there is not an acceptable alternative study, premedication and switching the contrast agent are recommended. The study should also be performed in a hospital setting with a rapid responses team available to treat anaphylaxis.
4. No premedication is necessary for patients with prior chemotoxic or physiologic reactions, isolated history of shellfish allergy or iodine allergy.
The committee found there is a lack of rigorous studies around contrast use due to the rarity of moderate and severe reactions to low-osmolality iodinated contrast agents, the paucity of methodologically sound studies and the heterogeneity of published studies.
Read the full guidelines here.
