Advertisement

Patients have very limited knowledge of their contrast allergies

      Highlights

      • Very few people with a prior allergic reaction to an iodinated-contrast agent know which agent they are allergic to.
      • Over half of people with a contrast allergy could not name where the reaction occurred, limiting old record acquisition.
      • Most people with a contrast allergy do not remember when the reaction occurred, limiting knowledge if the agent was older ionic, no longer commonly used.
      • Better documentation, education of patients and providers may improve knowledge of patients’ specific contrast allergies, helping tailor future studies.

      Abstract

      Purpose

      To quantify patients' knowledge of their iodinated contrast allergies; and to compare this data to literature estimates of patient knowledge of other medication allergies.

      Methods

      Using a key word search of 15,715 patients undergoing a total of 19,043 CT studies over a six-month period, a cohort of 307 adult patients claiming prior allergic reaction to iodinated intravenous contrast was identified. A patient questionnaire with the CT studies inquired about the specifics of their contrast allergy, including the symptoms of their prior allergic reaction; when and where the reaction occurred; and if patients could name the contrast agent to which they claim to be allergic.

      Results

      In the cohort of 307 patients claiming a prior allergic reaction to iodinated contrast, 86.6% could describe their prior allergic reaction symptoms. Only 36.8% could provide an approximate year of the reaction, with an additional 6.5% claiming that their reactions were remote, for a total of 43.3% providing some information when their reaction occurred. 56.7% provided no information on the year of their reaction. 40.7% named either the facility or the city where the reaction occurred, while 59.3% could not. Only 5 of 307 (1.6%, p < 0.00001) could name the contrast agent to which they believed they were allergic.

      Conclusion

      Other studies have reported inconsistencies, limited documentation, and limited ability to confirm patients' pharmacologic allergies, estimating that patients prior to pharmacist consultation are approximately 60-70% accurate in listing their drug allergies by name. Nevertheless, patients' knowledge of their iodinated contrast allergies is markedly more limited when compared to expected patient knowledge of medication allergies in general.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American College of Radiology Manual on Contrast Media
        • Wolf G.L.
        • Mishkin M.M.
        • Roux S.G.
        • Halpern E.F.
        • Gottlieb J.
        • Zimmerman J.
        • Gillen J.
        • Thellman C.
        Comparison of the rates of adverse drug reactions. Ionic contrast agents, ionic agents combined with steroids, and nonionic agents.
        Investig Radiol. 1991 May; 26: 404-410https://doi.org/10.1097/00004424-199105000-00003
        • Gomi T.
        • Nagamoto M.
        • Hasegawa M.
        • Katoh A.
        • Sugiyama M.
        • Murata N.
        • Kunihiro T.
        • Kohda E.
        Are there any differences in acute adverse reactions among five low-osmolar non-ionic iodinated contrast media?.
        Eur Radiol. 2010 Jul; 20 (Epub 2009 Dec 22): 1631-1635https://doi.org/10.1007/s00330-009-1698-6
        • Barrett B.J.
        • Parfrey P.S.
        • McDonald J.R.
        • Hefferton D.M.
        • Reddy E.R.
        • PJ McManamon
        Nonionic low-osmolality versus ionic high-osmolality contrast material for intravenous use in patients perceived to be at high risk: randomized trial.
        Radiology. 1992; 183https://doi.org/10.1148/radiology.183.1.1549654
        • Davenport M.S.
        • Cohan R.H.
        • Caoili E.M.
        • Ellis J.H.
        Repeat contrast medium reactions in premedicated patients: frequency and severity.
        Radiology. 2009; 253: 371-379https://doi.org/10.1148/radiol.2532090465
        • Deng F.
        • et al.
        Quality of documentation of contrast agent allergies in electronic health records.
        JACR. 2019; 16: 1027-1035https://doi.org/10.1016/j.jacr.2019.01.027
        • Park H.J.
        • Park J.W.
        • et al.
        Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study.
        Eur Radiol. 2017 Jul; 27 (Epub 2016 Dec 14): 2886-2893https://doi.org/10.1007/s00330-016-4682-y
        • Park S.J.
        • Kang D.Y.
        • et al.
        Immediate mild reactions to CT with iodinated contrast media: strategy of contrast media readministration without corticosteroids.
        Radiology. 2018 Sep; 288: 710-716https://doi.org/10.1148/radiol.2018172524
        • Abe S.
        • Fukuda H.
        • Tobe K.
        • Ibukuro K.
        Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium.
        Eur Radiol. 2016; 26 (ISSN: 1432-1084): 2148-2154
        • Cha M.J.
        • et al.
        Hypersensitivity reactions to iodinated contrast media: a multicenter study of 196,081 Patients.
        Radiology. 2019; 293: 117-124https://doi.org/10.1148/radiol.2019190485
        • McDonald J.S.
        • et al.
        Prevention of allergic-like reactions at repeat CT: steroid pretreatment versus contrast material substitution.
        Radiology. 2021; 000 (online ahead of print): 1-8
        • Beaty A.D.
        • Lieberman P.L.
        • Slavin R.G.
        Seafood allergy and radiocontrast media: are physicians propagating a myth?.
        Am J Med. 2008; 121: 158 e1-4https://doi.org/10.1016/j.amjmed.2007.08.025
        • Boehm I.
        Seafood allergy and radiocontrast media: are physicians propagating a myth?.
        Am J Med. 2008; 121e19https://doi.org/10.1016/j.amjmed.2008.03.035
        • Westermann-Clark E.
        • Pepper A.N.
        • Talreja N.
        • Lockey R.F.
        Debunking myths about “allergy” to radiocontrast media in an academic institution.
        Postgrad Med. 2015; 127: 295-300https://doi.org/10.1080/00325481.2015.1012918
        • Huang Shih-Wen
        Seafood and iodine: an analysis of a medical myth.
        Allergy Asthma Proc. Nov-Dec 2005; 26: 468-469
        • Coakley F.C.
        • Panicek D.M.
        Iodine allergy: an oyster without a pearl?.
        AJR. 1997; 169: 951-952https://doi.org/10.2214/ajr.169.4.9308442
        • Jarernsiripornkul N.
        • Chaipichit N.
        • Chumworathayi P.
        • Krska J.
        Management for improving patients’ knowledge and understanding about drug allergy.
        Pharm Pract. 2015 Jan-Mar; 13: 513https://doi.org/10.18549/pharmpract.2015.01.513
        • Jourdan A.
        • Sangha B.
        • Kim E.
        • et al.
        Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice.
        Allergy Asthma Clin Immunol. 2020; 16: 6https://doi.org/10.1186/s13223-020-0402-x
        • Sousa-Pinto B.
        • Almeida Fonseca J.
        • Rebelo Gomes E.
        Frequency of self-reported drug allergy: a systematic review and meta-analysis with meta-regression.
        Ann Allergy Asthma Immunol. 2017; 199: 362-373https://doi.org/10.1016/j.anai.2017.07.009
        • Wyatt J.P.
        Patients’ knowledge about their drug allergies.
        J Accid Emerg Med. 1996; 13: 114-115
      1. Shah NS, Ridgway JP, Pettit N, Fahrenbach J, Robicsek A. Documenting penicillin allergy: the impact of inconsistency. PLoS ONE 11(3): e0150514. https://doi.org/10.1371/journal.pone.0150514.