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Immediate hypersensitivity reactions to radiocontrast media: Clinical manifestations, diagnosis, and treatment

Sandra J Hong, MD
Sachiko T Cochran, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


More than 70 million diagnostic radiographic examinations using radiocontrast media (RCM) are performed worldwide each year, with at least 10 million in the United States alone [1]. Procedures using RCM include myelography, angiography (including cerebral arteriography), venography, urography, retrograde urography, endoscopic retrograde cholangiopancreatography (ERCP), arthrography, and computed tomography (CT). Adverse reactions occur predominantly in association with intravenous administration of RCM, but may also occur with intraarterial and nonvascular injections (eg, retrograde pyelography, intraarticular injections) of RCM [2].

This topic review discusses immediate hypersensitivity reactions (IHRs) to RCM, including their clinical presentation, epidemiology and risk factors, diagnosis, and management. The different types of RCM currently in use are also reviewed. Strategies to prevent repeat hypersensitivity reactions to RCM in patients who have previously experienced reactions are presented separately. (See "Immediate hypersensitivity reactions to radiocontrast media: Prevention of recurrent reactions".)


Radiocontrast media (RCM) can cause a variety of adverse reactions and the pathophysiology of most of these is poorly understood. As a result, various systems of classifying these reactions exist, based upon severity, timing, signs and symptoms, or presumed pathophysiology [3]. In this review, adverse reactions to RCM are divided into two broad categories: chemotoxic (including vasovagal) reactions and hypersensitivity reactions.

Chemotoxic and vasovagal reactions — Chemotoxic reactions, sometimes called physiologic reactions, are related to the chemical properties of radiocontrast agents and are dependent upon dose and infusion rate. These include seizures, arrhythmias, and organ (especially renal) toxicity [4-6]. Vasovagal reactions are sometimes considered in this group, although some patients develop vasovagal reactions from placement of the intravenous (IV) needed, even before any RCM is injected.

Chemotoxic reactions are considered related to the specific RCM, the osmolality, and the infusion rate. Relatively common reactions include warmth, flushing, nausea, or emesis and are usually transient and self-limited. These reactions do not preclude further administration of the particular contrast material. Some patients experience arm pain from the chemotoxicity of an intraarterial or intravenous infusion.

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Literature review current through: Nov 2017. | This topic last updated: Jun 23, 2017.
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