Immediate Hypersensitivity Reaction to Gadolinium-based MR Contrast Media

Published Online:https://doi.org/10.1148/radiol.12112025

The recurrence rate of immediate hypersensitivity reactions was 30% in patients who had previously experienced hypersensitivity reactions.

Purpose

To determine the incidence and risk factors of immediate hypersensitivity reactions to gadolinium-based magnetic resonance (MR) contrast agents.

Materials and Methods

Institutional review board approval and a waiver of informed consent were obtained. A retrospective study of patients who had been given gadolinium-based MR contrast media between August 2004 and July 2010 was performed by reviewing their electronic medical records. In addition to data on immediate hypersensitivity reaction, the kinds of MR contrast media and demographic data including age, sex, and comorbidity were collected. To compare the groups, the χ2 test, Fisher exact test, χ2 test for trend, Student t test, analysis of variance test, and multiple logistic regression test were performed.

Results

A total of 112 immediate hypersensitivity reactions (0.079% of 141 623 total doses) were identified in 102 patients (0.121% of 84 367 total patients). Among the six evaluated MR contrast media, gadodiamide had the lowest rate (0.013%) of immediate hypersensitivity reactions, while gadobenate dimeglumine had the highest rate (0.22%). The rate for immediate hypersensitivity reactions was significantly higher in female patients (odds ratio = 1.687; 95% confidence interval: 1.143, 2.491) and in patients with allergies and asthma (odds ratio = 2.829; 95% confidence interval: 1.427, 5.610). Patients with a previous history of immediate hypersensitivity reactions had a higher rate of recurrence after reexposure to MR contrast media (30%) compared with the incidence rate in total patients (P < .0001). The incidence of immediate hypersensitivity reactions increased depending on the number of times patients were exposed to MR contrast media (P for trend = .036). The most common symptom was urticaria (91.1%), and anaphylaxis occurred in 11 cases (9.8%). The mortality rate was 0.0007% because of one fatality.

Conclusion

The incidence of immediate hypersensitivity reactions to MR contrast media was 0.079%, and the recurrence rate of hypersensitivity reactions was 30% in patients with previous reactions.

© RSNA, 2012

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112025/-/DC1

References

  • 1 Dillman JR, Ellis JH, Cohan RH, Strouse PJ, Jan SC. Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults. AJR Am J Roentgenol 2007;189(6):1533–1538.
  • 2 Grobner T. Gadolinium: a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006;21(4):1104–1108.
  • 3 Marckmann P, Skov L. Nephrogenic systemic fibrosis: clinical picture and treatment. Radiol Clin North Am 2009;47(5):833–840.
  • 4 Runge VM. Safety of approved MR contrast media for intravenous injection. J Magn Reson Imaging 2000;12(2):205–213.
  • 5 Weiss KL. Severe anaphylactoid reaction after i.v. Gd-DTPA. Magn Reson Imaging 1990;8(6):817–818.
  • 6 Tardy B, Guy C, Barral G, Page Y, Ollagnier M, Bertrand JC. Anaphylactic shock induced by intravenous gadopentetate dimeglumine. Lancet 1992;339(8791):494.
  • 7 Bleicher AG, Kanal E. Assessment of adverse reaction rates to a newly approved MRI contrast agent: review of 23,553 administrations of gadobenate dimeglumine. AJR Am J Roentgenol 2008;191(6):W307–W311.
  • 8 Hunt CH, Hartman RP, Hesley GK. Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: retrospective review of 456,930 doses. AJR Am J Roentgenol 2009;193(4):1124–1127.
  • 9 Li A, Wong CS, Wong MK, Lee CM, Au Yeung MC. Acute adverse reactions to magnetic resonance contrast media: gadolinium chelates. Br J Radiol 2006;79(941):368–371.
  • 10 Kirchin MA, Runge VM. Contrast agents for magnetic resonance imaging: safety update. Top Magn Reson Imaging 2003;14(5):426–435.
  • 11 Prince MR, Zhang H, Zou Z, Staron RB, Brill PW. Incidence of immediate gadolinium contrast media reactions. AJR Am J Roentgenol 2011;196(2):W138–W143.
  • 12 Murphy KP, Szopinski KT, Cohan RH, Mermillod B, Ellis JH. Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: a survey of the American Society of Neuroradiology Fellowship Directors. Acad Radiol 1999;6(11):656–664.
  • 13 Brockow K, Christiansen C, Kanny G, et al.. Management of hypersensitivity reactions to iodinated contrast media. Allergy 2005;60(2):150–158.
  • 14 Brockow K. Contrast media hypersensitivity: scope of the problem. Toxicology 2005;209(2):189–192.
  • 15 Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function: measured and estimated glomerular filtration rate. N Engl J Med 2006;354(23):2473–2483.
  • 16 Edwards IR, Biriell C. Harmonisation in pharmacovigilance. Drug Saf 1994;10(2):93–102.
  • 17 Meyboom RH, Hekster YA, Egberts AC, Gribnau FW, Edwards IR. Causal or casual? the role of causality assessment in pharmacovigilance. Drug Saf 1997;17(6):374–389.
  • 18 ACR manual on contrast media, version 7, 2010. American College of Radiology. http://www.nxtbook.com/nxtbooks/arrs/contrastmediamanual2010/#/0. Published 2010. Accessed June 28, 2011.
  • 19 Sampson HA, Muñoz-Furlong A, Campbell RL, et al.. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006;117(2):391–397.
  • 20 Niendorf HP, Dinger JC, Haustein J, Cornelius I, Alhassan A, Clauss W. Tolerance data of Gd-DTPA: a review. Eur J Radiol 1991;13(1):15–20.
  • 21 Nelson KL, Gifford LM, Lauber-Huber C, Gross CA, Lasser TA. Clinical safety of gadopentetate dimeglumine. Radiology 1995;196(2):439–443.
  • 22 Maddox TG. Adverse reactions to contrast material: recognition, prevention, and treatment. Am Fam Physician 2002;66(7):1229–1234.
  • 23 Cohan RH, Ellis JH. Iodinated contrast material in uroradiology: choice of agent and management of complications. Urol Clin North Am 1997;24(3):471–491.
  • 24 Hasdenteufel F, Luyasu S, Renaudin JM, et al.. Anaphylactic shock after first exposure to gadoterate meglumine: two case reports documented by positive allergy assessment. J Allergy Clin Immunol 2008;121(2):527–528.
  • 25 Galera C, Pur Ozygit L, Cavigioli S, Bousquet PJ, Demoly P. Gadoteridol-induced anaphylaxis: not a class allergy. Allergy 2010;65(1):132–134.

Article History

Received September 22, 2011; revision requested October 28; revision received January 9, 2012; accepted February 3; final version accepted March 1.
Published online: Aug 2012
Published in print: Aug 2012