Hypersensitivity Reactions to Iodinated Contrast Media: A Narrative Review of Current Evidence and Clinical Challenges

TL;DR

This review discusses the challenges in diagnosing and managing allergic reactions to iodinated contrast media used in medical imaging.

Contribution

The paper provides a comprehensive overview of current diagnostic methods and unresolved issues in managing hypersensitivity to iodinated contrast media.

Findings

Skin tests have limited sensitivity, especially for non-immediate reactions to iodinated contrast media.

Cross-reactivity among iodinated contrast media is common but unpredictable.

Drug provocation tests are the gold standard for diagnosis but lack standardized protocols.

Abstract

Background/Objectives: Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM), both immediate and non-immediate, pose clinical challenges despite using low-osmolality agents. This review aims to summarize current diagnostic approaches, cross-reactivity patterns, and the debated role of premedication. Methods: A narrative review was conducted using PubMed (2014–2024), selecting studies on ICM-related HSRs, focusing on skin and in vitro testing, drug provocation tests (DPTs), cross-reactivity, and premedication. Results: Skin tests show limited sensitivity, especially for non-immediate reactions. Cross-reactivity among ICMs is common but unpredictable. DPTs are the diagnostic gold standard but lack standardized protocols. Premedication is frequently used, though its efficacy remains uncertain. Conclusions: The management of ICM hypersensitivity is limited by diagnostic gaps and insufficient evidence on premedication. Standardized protocols and prospective studies are needed to improve patient safety and guide clinical decisions.

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