Why mild contrast medium-induced reactions are sometimes over-treated and moderate/severe reactions of internal organs are undertreated: a summary based on RadioComics

Excerpt

Patients with underlying conditions, such as allergic predisposition or specifically contrast medium-allergy are at increased risk to acquire an adverse drug reaction upon re-exposure to contrast materials, and therefore should undergo a prophylactic management before receiving contrast medium (CM) [1, 2]. Interestingly, patients with minor and harmless complaints following CM injection, such as erythema, regularly receive a maximal pre-treatment (e.g., prednisolone plus H1-antagonist) [3] (Fig. 1). On the other hand, patients with reduced kidney function, renal insufficiency, and nephrotoxic medication should also undergo special prophylaxis protocols, such as naïve examination (without CM), low-dose CM application, or will be referred to an alternative modality [4], especially when multiple CM-applications during the last 2–3 days have been given. The experience shows that such patients are rarely candidates for a prophylaxis (Fig. 1). Therefore, the objective of this paper is to draw attention to the phenomenon that patients with a history of mild cutaneous CM reactions are subjected more frequently and intensively to premedication than patients with moderate to severe systemic reactions. …