Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults

Jonathan R Dillman, James H Ellis, Richard H Cohan, Peter J Strouse, Sophia C Jan
AJR. American Journal of Roentgenology 2007, 189 (6): 1533-8

OBJECTIVE: The purpose of our study was to determine the frequency and severity of acute allergic-like reactions to i.v.-administered gadolinium-containing contrast media in children and adults.

MATERIALS AND METHODS: Pediatric (younger than 19 years) and adult department of radiology contrast material reaction forms involving patients who experienced acute allergic-like reactions to gadolinium-containing contrast media from January 1, 2001, through December 31, 2006, were retrospectively evaluated for the specific types of acute allergic-like reactions, reaction management, and patient outcomes. Relevant patient medical information, including documentation of prior gadolinium- or iodine-containing contrast material reaction, premedication before acute allergic-like reaction to i.v. gadolinium-containing contrast material, previous allergic reactions to substances other than contrast media, and history of asthma, was obtained by reviewing electronic medical records.

RESULTS: Seventy-eight thousand three hundred fifty-three (65,009 adult and 13,344 pediatric) i.v. administrations of gadolinium-containing contrast material were performed during the study period. Acute allergic-like reactions were documented after 54 injections (reaction frequency, 0.07%). Forty-eight reactions involved adult patients (adult reaction frequency, 0.07%), and six reactions occurred in pediatric patients (pediatric reaction frequency, 0.04%). Forty (74%) acute allergic-like reactions were mild, 10 (19%) were moderate, and four (7%) were severe. No gadolinium-containing contrast material-related death occurred during the study period. Twenty-six (50%) of 52 patients had one or more presumed risk factors for contrast material reaction.

CONCLUSION: Adult and pediatric acute allergic-like reactions to i.v.-administered gadolinium-containing contrast media are rare. Most of these reactions are mild; however, moderate and severe reactions that require immediate management do occur.

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