Top

Published in:

01-07-2006 | Contrast Media

A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions

Authors: Ingrid Böhm, Hans H. Schild

Published in: European Radiology | Issue 7/2006

Abstract

The terms “immediate” and “delayed” adverse reactions induced by contrast media (CM) refer to the reactions' onset but do not provide substantial information concerning the clinical manifestation, the potential risk factors, the treatment modalities, or prevention. Because a variety of different reactions caused by different pathophysiological mechanisms may arise immediately or be delayed after CM injection, and because these need different management, the aim of the present paper is to present the clinical features and to exactly characterize lesser-known cutaneous reactions. A thorough knowledge of the clinical features, their adequate treatment, and, possibly, the subsequent diagnostic procedure for preventing recurrence after reexposure to CM would improve patient management.

Morcos SK, Thomsen HS (2001) Adverse reactions to iodinated contrast media. Eur Radiol 11(7):1267–1275CrossRefPubMed

Thomsen HS, Morcos SK, Contrast Media Safety Committee of European Society of Urogenital Radiology (2004) Management of acute adverse reactions to contrast media. Eur Radiol 14:476–481CrossRefPubMed

Morcos SK (2005) Acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol 78:686–693CrossRefPubMed

Webb JA, Stacul F, Thomsen HS, Morcos SK, members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology (2003) Late adverse reactions to intravascular iodinated contrast media. Eur Radiol 13(1):181–184PubMed

Christiansen C, Pichler WJ, Skotland T (2000) Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations. Eur Radiol 10:1965–1975CrossRefPubMed

Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K (1990) Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 175:621–628PubMed

No authors listed G (1996) Delayed allergy-like reactions to X-ray contrast media. Exploration of the problem. Eur Radiol 6(5 Suppl):1–24CrossRefPubMed

Pohly JP (1998) Onset of late adverse drug reactions to dimeric non-ionic contrast media: iotrolan, iodixanol. Pharmacoepidemiol Drug Saf 7(Suppl 1):S18–S22CrossRefPubMed

Dooley M, Jarvis B (2000) Iomeprol: a review of its use as a contrast medium. Drugs 59:1169–1186CrossRefPubMed

10.

Muth CP, Henseke P, Grynne BH (1997) Iopentol (Imagopaque) in vascular procedures. A multi-centre monitoring trial assessing adverse events and diagnostic information-results from 3,587 patients in Germany. Eur Radiol 7(Suppl 4):S104–S108CrossRefPubMed

11.

Doerfler A, Fiebach J, Wanke I, Forsting M, Henseke P, Sartor K (1999) Iodixanol in cerebral computed tomography: a randomized, double-blind, phase-III, parallel study with iodixanol and iohexol. Eur Radiol 9:1362–1365CrossRefPubMed

12.

Federle MP, Chezmar JL, Rubin DL, Weinreb JC, Freeny PC, Semelka RC, Brown JJ, Borello JA, Lee JK, Mattrey R, Dachman AH, Saini S, Harmon B, Fenstermacher M, Pelsang RE, Harms SE, Mitchell DG, Halford HH, Anderson MW, Johnson CD, Francis IR, Bova JG, Kenney PJ, Klippenstein DL, Foster GS, Turner DA (2000) Safety and efficacy of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. multicenter phase III clinical trials (safety). J Magn Reson Imaging 12:186–197CrossRefPubMed

13.

Wang C, Gordon PB, Hustvedt SO, Grant D, Sterud AT, Martinsen I, Ahlstrom H, Hemmingsson A (1997) MR imaging properties and pharmacokinetics of MnDPDP in healthy volunteers. Acta Radiol 38:665–676PubMed

14.

Kim SH, Cho JY, Lim HK (1999) CT findings of isolated small bowel angioedema due to iodinated radiographic contrast medium reaction. Abdom Imaging 24:117–119CrossRefPubMed

15.

Bennasr S, Magnier S, Hassan M, Jacqz-Aigrain E (1994) Anaphylactic shock and low osmolarity contrast medium. Arch Pediatr 1:155–157PubMed

16.

Lieberman P, Siegle RL, Kaplan RJ, Hashimoto K (1976) Chronic urticaria and intermittent anaphylaxis. Reactions to lophendylate. JAMA 236:1495–1497CrossRefPubMed

17.

Laroche D, Namour F, Lefrancois C, Aimone-Gastin I, Romano A, Sainte-Laudy J, Laxenaire MC, Gueant JL (1999) Anaphylactoid and anaphylactic reactions to iodinated contrast material. Allergy Suppl 58:13–16CrossRef

18.

Laroche D, Aimone-Gastin I, Dubois F, Huet H, Gerard P, Vergnaud MC, Mouton-Faivre C, Gueant JL, Laxenaire MC, Bricard H (1998) Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology 209:183–190PubMed

19.

Kurabayashi T, Ida M, Fukayama H, Ohbayashi N, Yoshino N, Sasaki T (1998) Adverse reactions to nonionic iodine in contrast-enhanced computed tomography: usefulness of monitoring vital signs. Dentomaxillofac Radiol 27:199–202CrossRefPubMed

20.

Bendel, Hoogland PH (1984) Quincke oedema following intrathecal administration of metrizamide. Neuroradiology 26:415–416CrossRefPubMed

21.

Ekholm S, Jonsson E, Sandvik L, Fagerlund M, Holtas S, Isberg B, Lindell D, Linden B, Sjoberg S, Thuomas KA, Tollesson PO (1996) Tolerance and efficacy of Omniscan (gadodiamide injection) in MR imaging of the central nervous system. Acta Radiol 37:223–228PubMed

22.

Seiderer M (1992) Phase III clinical studies with gadoteridol for the evaluation of neurologic pathology. A European perspective. Invest Radiol 27(Suppl 1):S33–S38PubMed

23.

Murphy KJ, Brunberg JA, Cohan RH (1996) Adverse reactions to gadolinium contrast media: a review of 36 cases. AJR Am J Roentgenol 167:847–849PubMed

24.

Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wuthrich B, EAACI (the European Academy of Allergology and Clinical Immunology) Nomenclature Task Force (2001) A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 56:813–824CrossRefPubMed

25.

Miyauchi T, Hirano T, Ushiyama C, Ovary Z, Okumura K, Katayama H (1996) Anaphylactic IgE and IgG1 production for hapten can be enhanced by contrast media. Br J Radiol 69:920–924PubMedCrossRef

26.

Hoffmeister HM, Heller W (1996) Radiographic contrast media and the coagulation and complement systems. Invest Radiol 31(9):591–595CrossRefPubMed

27.

Lasser EC, Lang JH, Lyon SG, Hamblin AE (1980) Changes in complement and coagulation factors in a patient suffering a severe anaphylactoid reaction to injected contrast material: some considerations of pathogenesis. Invest Radiol 15(6 Suppl):S6–S12PubMedCrossRef

28.

Böhm I, Speck U, Schild H (2005) A possible role for cysteinyl-leukotrienes in non-ionic contrast media induced adverse reactions. Eur J Radiol 55:431–436CrossRefPubMed

29.

Goss JE, Chambers CE, Heupler FA Jr (1995) Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis, and treatment. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions. Cathet Cardiovasc Diagn 34:99–104PubMedCrossRef

30.

Morcos SK, Thomsen HS, Webb JA; Contrast Media Safety Committee of the European Society of Urogenital Radiology (2001) Prevention of generalized reactions to contrast media: a consensus report and guidelines. Eur Radiol 11:1720–1728CrossRefPubMed

31.

Ring J, Rothenberger KH, Clauss W (1985) Prevention of anaphylactoid reactions after radiographic contrast media infusion by combined histamine H1- and H2-receptor antagonists: results of a prospective controlled trial. Int Arch Allergy Appl Immunol 78:9–14PubMed

32.

Gall H, Pillekamp H, Peter RU (1999) Late-type allergy to the X-ray contrast medium Solutrast (iopamidol). Contact Dermatitis 40:248–250PubMedCrossRef

33.

Brockow K, Kiehn M, Kleinheinz A, Vieluf D, Ring J (1999) Positive skin tests in late reactions to radiographic contrast media. Allerg Immunol (Paris) 31:49–51

34.

Courvoisier S, Bircher AJ (1998) Delayed-type hypersensitivity to a nonionic, radiopaque contrast medium. Allergy 53:1221–1224PubMedCrossRef

35.

Brockow K (2005) Contrast media hypersensitivity-scope of the problem. Toxicology 209:189–192CrossRefPubMed

36.

Kanny G, Pichler W, Morisset M, Franck P, Marie B, Kohler C, Renaudin JM, Beaudouin E, Laudy JS, Moneret-Vautrin DA (2005) T cell-mediated reactions to iodinated contrast media: evaluation by skin and lymphocyte activation tests. J Allergy Clin Immunol 115:179–185CrossRefPubMed

37.

Brockow K, Kiehn M, Kleinheinz A, Vieluf D, Ring J (1999) Positive skin tests in late reactions to radiographic contrast media. Allerg Immunol (Paris) 31:49–51

38.

Barbaud A (2005) Drug patch testing in systemic cutaneous drug allergy. Toxicology 209:209–216CrossRefPubMed

39.

Vernassiere C, Trechot P, Commun N, Schmutz JL, Barbaud A (2004) Low negative predictive value of skin tests in investigating delayed reactions to radio-contrast media. Contact Dermatitis 50:359–366CrossRefPubMed

40.

Savill JS, Barrie R, Ghosh S, Muhlemann M, Dawson P, Pusey CD (1988) Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus. Postgrad Med J 64:392–394PubMedCrossRef

41.

Ghislain PD, Roujeau JC (2002) Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J 8:5PubMed

42.

Lee ML, Chiu IS (2002) Toxic epidermal necrolysis incriminating iopamidol in a child after cardiac catheterization. Int J Cardiol 82:95–97CrossRefPubMed

43.

Wood BP, Lane AT, Rabinowitz R (1988) Cutaneous reaction to contrast material. Radiology 169:739–740PubMed

44.

Laffitte E, Nenadov Beck M, Hofer M, Hohl D, Panizzon RG (2004) Severe Stevens-Johnson syndrome induced by contrast medium iopentol (Imagopaque). Br J Dermatol 150:376–378CrossRefPubMed

45.

Rosado A, Canto G, Veleiro B, Rodriguez J (2001) Toxic epidermal necrolysis after repeated injections of iohexol. AJR Am J Roentgenol 176:262–263PubMed

46.

Schmidt BJ, Foley WD, Bohorfoush AG (1998) Toxic epidermal necrolysis related to oral administration of diluted diatrizoate meglumine and diatrizoate sodium. AJR Am J Roentgenol 171:1215–1216PubMed

47.

Kaftori JK, Abraham Z, Gilhar A (1988) Toxic epidermal necrolysis after excretory pyelography. Immunologic-mediated contrast medium reaction? Int J Dermatol 27:346–347PubMedCrossRef

48.

Sadi AM, Toda T, Kiyuna M, Tamamoto T, Ohshiro K, Shinzato R (1995) An autopsy case of malignant lymphoma with Lyell’s syndrome. J Dermatol 22:594–599PubMed

49.

Friedmann PS, Strickland I, Pirmohamed M, Park BK (1994) Investigation of mechanisms in toxic epidermal necrolysis induced by carbamazepine. Arch Dermatol 130:598–604CrossRefPubMed

50.

Inachi S, Mizutani H, Shimizu M (1997) Epidermal apoptotic cell death in erythema multiforme and Stevens-Johnson syndrome. Contribution of perforin-positive cell infiltration. Arch Dermatol 133:845–849CrossRefPubMed

51.

Schnyder B, Frutig K, Mauri-Hellweg D, Limat A, Yawalkar N, Pichler WJ (1998) T-cell-mediated cytotoxicity against keratinocytes in sulfamethoxazol-induced skin reaction. Clin Exp Allergy 28:1412–1417CrossRefPubMed

52.

Correia O, Delgado L, Ramos JP, Resende C, Torrinha JA (1993) Cutaneous T-cell recruitment in toxic epidermal necrolysis. Further evidence of CD8+ lymphocyte involvement. Arch Dermatol 129:466–468CrossRefPubMed

53.

Bagot M, Charue D, Heslan M, Wechsler J, Roujeau JC, Revuz J (1993) Impaired antigen presentation in toxic epidermal necrolysis. Arch Dermatol 129:721–727CrossRefPubMed

54.

Leyva L, Torres MJ, Posadas S, Blanca M, Besso G, O’Valle F, del Moral RG, Santamar LF, Ju C (2000) Anticonvulsant-induced toxic epidermal necrolysis: monitoring the immunologic response. J Allergy Clin Immunol 105:157–165CrossRefPubMed

55.

Paquet P, Paquet F, Al Saleh W, Reper P, Vanderkelen A, Pierard GE (2000) Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Am J Dermatopathol 22:413–417PubMedCrossRef

56.

Le Cleach L, Delaire S, Boumsell L, Bagot M, Bourgault-Villada I, Bensussan A, Roujeau JC (2000) Blister fluid T lymphocytes during toxic epidermal necrolysis are functional cytotoxic cells which express human natural killer (NK) inhibitory receptors. Clin Exp Immunol 119:225–230CrossRefPubMed

57.

Paquet P, Pierard GE (1997) Erythema multiforme and toxic epidermal necrolysis: a comparative study. Am J Dermatopathol 19:127–132CrossRefPubMed

58.

Akiyama M, Iijima M, Fujisawa R (1990) Clinical analysis of drug eruption due to iohexol (Omnipaque). Nippon Hifuka Gakkai Zasshi 100:1057–1060PubMed

59.

Benson PM, Giblin WJ, Douglas DM (1990) Transient, nonpigmenting fixed drug eruption caused by radiopaque contrast media. J Am Acad Dermatol 23:379–381PubMedCrossRef

60.

Asano S, Ikeda M, Ichikawa E, Okabe S, Kawamura T, Maeda M (1990) Drug eruption due to iohexol (Omnipaque). Rinsho Hoshasen 35:533–536PubMed

61.

Good AE, Novak E, Sonda LP (1980) Fixed eruption and fever after urography. South Med J 73:948–949PubMed

62.

Yamauchi R, Morita A, Tsuji T (1997) Fixed drug eruption caused by iopamidol, a contrast medium. J Dermatol 24:243–245PubMed

63.

Watanabe H, Sueki H, Nakada T, Akiyama M, Iijima M (1999) Multiple fixed drug eruption caused by iomeprol (Iomeron), a nonionic contrast medium. Dermatology 198:291–294CrossRefPubMed

64.

Teraki Y, Moriya N, Shiohara T (1994) Drug-induced expression of intercellular adhesion molecule-1 on lesional keratinocytes in fixed drug eruption. Am J Pathol 145:550–560PubMed

65.

Boudoulas O, Siegle RJ, Grimwood RE (1987) Iododerma occurring after orally administered iopanoic acid. Arch Dermatol 123:387–388CrossRefPubMed

66.

Heydenreich G, Larsen PO (1977) Iododerma after high dose urography in an oliguric patient. Br J Dermatol 97:567–569PubMedCrossRef

67.

Vaillant L, Pengloan J, Blanchier D, De Muret A, Lorette G (1990) Iododerma and acute respiratory distress with leucocytoclastic vasculitis following the intravenous injection of contrast medium. Clin Exp Dermatol 15:232–233CrossRefPubMed

68.

Miranda-Romero A, Sanchez-Sambucety P, Esquivias Gomez JI, Martinez Fernandez M, Bajo del Pozo C, Aragoneses Fraile H, Garcia-Munoz M (1999) Vegetating iododerma with fatal outcome. Dermatology 198:295–297CrossRefPubMed

69.

Sparrow GP (1979) Iododerma due to radiographic contrast medium. J R Soc Med 72:60–61PubMed

70.

Chang MW, Miner JE, Moiin A, Hashimoto K (1997) Iododerma after computed tomographic scan with intravenous radiopaque contrast media. J Am Acad Dermatol 36:1014–1016PubMedCrossRef

71.

Fransson SG, Stenport G, Andersson M (1996) Immediate and late adverse reactions in coronary angiography. A comparison between iodixanol and ioxaglate. Acta Radiol 37:218–222PubMed

72.

Hosoya T, Yamaguchi K, Akutsu T, Mitsuhashi Y, Kondo S, Sugai Y, Adachi M (2000) Delayed adverse reactions to iodinated contrast media and their risk factors. Radiat Med 18:39–45PubMed

73.

Rydberg J, Charles J, Aspelin P (1998) Frequency of late allergy-like adverse reactions following injection of intravascular non-ionic contrast media. A retrospective study comparing a non-ionic monomeric contrast medium with a non-ionic dimeric contrast medium. Acta Radiol 39:219–222PubMedCrossRef

74.

Kanzaki T, Sakagami H (1991) Late phase allergic reaction to a CT contrast medium (iotrolan). J Dermatol 18:528–531PubMed

75.

Sutton AG, Finn P, Grech ED, Hall JA, Stewart MJ, Davies A, de Belder MA (2001) Early and late reactions after the use of iopamidol 340, ioxaglate 320, and iodixanol 320 in cardiac catheterization. Am Heart J 141:677–683CrossRefPubMed

76.

Orasch CE, Helbling A, Zanni MP, Yawalkar N, Hari Y, Pichler WJ (1999) T-cell reaction to local anaesthetics: relationship to angioedema and urticaria after subcutaneous application-patch testing and LTT in patients with adverse reaction to local anaesthetics. Clin Exp Allergy 29:1549–1554CrossRefPubMed

Title: A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions
Authors: Ingrid Böhm
Hans H. Schild
Publication date: 01-07-2006
Publisher: Springer-Verlag
Published in: European Radiology / Issue 7/2006
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-006-0202-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2006

Quantitative MRI comparison of pulmonary hemodynamics in mustard/senning-repaired patients suffering from transposition of the great arteries and healthy volunteers at rest

Direct detector radiography versus dual reading computed radiography: feasibility of dose reduction in chest radiography

CAD for mammography: the technique, results, current role and further developments

Imaging of hamstring injuries: therapeutic implications

Contemporary issues in the diagnosis of prostate cancer for the radiologist

Recent literature