Adverse reactions to contrast material: recognition, prevention, and treatment.

Adverse reactions to contrast agents range from a mild inconvenience, such as itching associated with hives, to a life-threatening emergency. Renal toxicity is a well known adverse reaction associated with the use of intravenous contrast material. Other forms of adverse reactions include delayed allergic reactions, anaphylactic reactions, and local tissue damage. Previous allergic reactions to contrast material, asthma, and allergies are factors associated with an increased risk of developing an adverse reaction. Pretreatment of patients who have such risk factors with a corticosteroid and diphenhydramine decreases the chance of allergic reactions, including anaphylaxis, renal failure, or a possible life-threatening emergency. Awareness of the different types of risk factors and prescreening for their presence allows for early recognition and prompt treatment. Prophylactic treatment before administration of contrast material can prevent potential adverse reactions. If such reactions do occur, prompt recognition allows them to be treated immediately. Using the smallest amount of contrast material possible and low-molecular, nonionic agents also decreases the relative risk of reactions. Renal insufficiency induced by contrast material may be prevented by ensuring adequate hydration and discontinuing other nephrotoxic medications before the procedure. Low-osmolar, nonionic agents are helpful in patients with known conditions associated with adverse reactions.

[1]  S. Dorph,et al.  Adverse reactions to urographic contrast medium. Rapid versus slow injection rate. , 1980, The British journal of radiology.

[2]  F. H. Gerber,et al.  Pretreatment with Corticosteroids to Alleviate Reactions to Intravenous Contrast Material , 1988 .

[3]  S. Morcos.  Contrast media-induced nephrotoxicity--questions and answers. , 1998, The British journal of radiology.

[4]  F. Gilbert,et al.  Metformin and contrast media--a dangerous combination? , 1999, Clinical Radiology.

[5]  A. Schoenfeld,et al.  Radiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media. , 1991, AJR. American journal of roentgenology.

[6]  W. Bank,et al.  Renal failure after major angiography can be avoided with hydration. , 1981, AJR. American journal of roentgenology.

[7]  Jordan J. Cohen,et al.  Hospital-Acquired Renal Insufficiency: A Prospective Study , 1983 .

[8]  C. Sawmiller,et al.  Contrast-Induced Nephropathy: Review of Incidence and Pathophysiology , 1998, Annals of vascular surgery.

[9]  M. Tublin,et al.  Current concepts in contrast media-induced nephropathy. , 1998, AJR. American journal of roentgenology.

[10]  R. Patterson,et al.  Prophylaxis against repeated radiocontrast media reactions in 857 cases. Adverse experience with cimetidine and safety of beta-adrenergic antagonists. , 1985, Archives of internal medicine.

[11]  D. Carr,et al.  Contrast media reactions: experimental evidence against the allergy theory. , 1984, The British journal of radiology.

[12]  P. Lieberman,et al.  Radiographic contrast media studies in high-risk patients. , 1978, The Journal of allergy and clinical immunology.

[13]  P. Lieberman,et al.  Administration of Radiographic Contrast Media in High‐risk Patients , 1980, Investigative Radiology.

[14]  A. Wenning,et al.  Prevention of radiocontrast-media-induced nephrotoxicity by the calcium channel blocker nitrendipine: a prospective randomised clinical trial. , 1989, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[15]  M. Brezis,et al.  Potential deleterious effect of furosemide in radiocontrast nephropathy. , 1992, Nephron.

[16]  T. Kozuka,et al.  Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. , 1990, Radiology.

[17]  J. Ellis,et al.  Iodinated contrast material in uroradiology. Choice of agent and management of complications. , 1997, The Urologic clinics of North America.