Hypersensitivity reactions to contrast media: Part 1. Management of immediate and non-immediate hypersensitivity reactions in adults. Updated guidelines by the ESUR Contrast Media Safety Committee

Hypersensitivity reactions to iodine-based, gadolinium-based and ultrasound contrast agents are a heterogeneous group that occur infrequently and can be classified as either immediate or non-immediate. In imaging, most are mild or moderate, while severe reactions are very rare. A standardized risk assessment and close patient monitoring are crucial. In addition to liberal use of supportive treatment by oxygen and volume expansion, the main drugs for treatment of individual reactions include intramuscular adrenaline and H1-antihistamines, with limited indications for short-acting β2-agonists (SABA) like salbutamol or albuterol. As these reactions occur infrequently, these situations often create stress and confusion. During treatment, the stability or progression of the reaction should be constantly assessed, assigning a specific task to each team member. In addition, detailed documentation and correct classification of the severity of such reactions will help improve the risk management in future imaging studies. Regular hands-on training for all personnel involved in managing these reactions is mandatory. To help, the ESUR Contrast Media Safety Committee has reviewed the literature on hypersensitivity reactions and updated its guidance on how to appropriately manage, treat, and document immediate and non-immediate hypersensitivity reactions to contrast media in adults. Key Points: Question Hypersensitivity reactions to contrast media may require immediate action to prevent further damage to the patient. Guidance on management would help improving preparedness. Findings Clear treatment protocols with cards or flowcharts are mandatory. Intramuscular adrenaline is the most important drug for treatment. Documentation should be agent-specific and standardized. Clinical relevance The ESUR Contrast Media Safety Committee has updated its guidance on how to appropriately manage, treat, and document immediate and non-immediate hypersensitivity reactions to contrast media in adults.