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Hypersensitivity reactions to contrast media: Part 2. Prevention of recurrent hypersensitivity reactions in adults. Updated guidelines by the ESUR Contrast Media Safety Committee.

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Title: Hypersensitivity reactions to contrast media: Part 2. Prevention of recurrent hypersensitivity reactions in adults. Updated guidelines by the ESUR Contrast Media Safety Committee.
Authors: van der Molen, Aart J.1 (AUTHOR) A.J.van_der_Molen@lumc.nl, van de Ven, Annick A. J. M.2 (AUTHOR), Vega, Francisco3 (AUTHOR), Dekkers, Ilona A.1,4 (AUTHOR), Geenen, Remy W. F.5 (AUTHOR), Bellin, Marie-France6 (AUTHOR), Bertolotto, Michele7 (AUTHOR), Brismar, Torkel B.8 (AUTHOR), Clément, Olivier9 (AUTHOR), Correas, Jean-Michel10 (AUTHOR), Deike, Katerina11,12 (AUTHOR), Heinz, Gertraud13 (AUTHOR), Mahnken, Andreas H.14 (AUTHOR), Mallio, Carlo A.15 (AUTHOR), Quattrocchi, Carlo C.16 (AUTHOR), Radbruch, Alexander11 (AUTHOR), Reimer, Peter17 (AUTHOR), Roditi, Giles18 (AUTHOR), Romanini, Laura19 (AUTHOR), Sebastià, Carmen20 (AUTHOR)
Source: European Radiology. Nov2025, Vol. 35 Issue 11, p6811-6825. 15p.
Subjects: Contrast media, Secondary prevention, Adults, Tryptase, Allergies
Abstract: Hypersensitivity reactions to contrast media are infrequent and can occur either within the first 60 min following their intravascular administration (immediate reactions) or at a later time point (non-immediate reactions). Most hypersensitivity reactions are mild or moderate, while severe reactions are rare (less than 1 in every 10,000 administrations). After any moderate or severe immediate adverse reaction, serum tryptase must be measured within 1–4 h from the onset of symptoms and at least 24 h after symptoms have disappeared to confirm a hypersensitivity reaction. At least for all moderate-to-severe hypersensitivity reactions, the patient should be referred to a drug allergy specialist for an allergy evaluation with a panel of contrast media, and optionally, all hypersensitivity reactions when local drug allergy specialist capacity allows. Selecting an alternative contrast medium based on practical experience is challenging due to its high and variable cross-reactivity; therefore, the best option is to choose an alternative based on the results of an allergy evaluation. This approach is safer and more effective than premedication for preventing recurrent hypersensitivity reactions. Key Points: QuestionWhat is the optimal strategy in clinical practice to prevent recurrent hypersensitivity reactions in adults who previously experienced a hypersensitivity reaction to contrast media? FindingsSerum tryptase should be measured within 1–4 h after a moderate or severe reaction, and at least all moderate or severe hypersensitivity reactions should be referred to an allergologist. Clinical relevanceManagement strategies should be adapted to the type and severity of the reaction, as well as the urgency of required re-administration. Changing from the culprit contrast agent to another molecule with differing side-chains is more effective than premedication. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Hypersensitivity reactions to contrast media: Part 2. Prevention of recurrent hypersensitivity reactions in adults. Updated guidelines by the ESUR Contrast Media Safety Committee.
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  Data: <searchLink fieldCode="AR" term="%22van+der+Molen%2C+Aart+J%2E%22">van der Molen, Aart J.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> A.J.van_der_Molen@lumc.nl</i><br /><searchLink fieldCode="AR" term="%22van+de+Ven%2C+Annick+A%2E+J%2E+M%2E%22">van de Ven, Annick A. J. M.</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vega%2C+Francisco%22">Vega, Francisco</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dekkers%2C+Ilona+A%2E%22">Dekkers, Ilona A.</searchLink><relatesTo>1,4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Geenen%2C+Remy+W%2E+F%2E%22">Geenen, Remy W. F.</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bellin%2C+Marie-France%22">Bellin, Marie-France</searchLink><relatesTo>6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bertolotto%2C+Michele%22">Bertolotto, Michele</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brismar%2C+Torkel+B%2E%22">Brismar, Torkel B.</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Clément%2C+Olivier%22">Clément, Olivier</searchLink><relatesTo>9</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Correas%2C+Jean-Michel%22">Correas, Jean-Michel</searchLink><relatesTo>10</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Deike%2C+Katerina%22">Deike, Katerina</searchLink><relatesTo>11,12</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Heinz%2C+Gertraud%22">Heinz, Gertraud</searchLink><relatesTo>13</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mahnken%2C+Andreas+H%2E%22">Mahnken, Andreas H.</searchLink><relatesTo>14</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mallio%2C+Carlo+A%2E%22">Mallio, Carlo A.</searchLink><relatesTo>15</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Quattrocchi%2C+Carlo+C%2E%22">Quattrocchi, Carlo C.</searchLink><relatesTo>16</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Radbruch%2C+Alexander%22">Radbruch, Alexander</searchLink><relatesTo>11</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Reimer%2C+Peter%22">Reimer, Peter</searchLink><relatesTo>17</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Roditi%2C+Giles%22">Roditi, Giles</searchLink><relatesTo>18</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Romanini%2C+Laura%22">Romanini, Laura</searchLink><relatesTo>19</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sebastià%2C+Carmen%22">Sebastià, Carmen</searchLink><relatesTo>20</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Nov2025, Vol. 35 Issue 11, p6811-6825. 15p.
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  Data: <searchLink fieldCode="DE" term="%22Contrast+media%22">Contrast media</searchLink><br /><searchLink fieldCode="DE" term="%22Secondary+prevention%22">Secondary prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Tryptase%22">Tryptase</searchLink><br /><searchLink fieldCode="DE" term="%22Allergies%22">Allergies</searchLink>
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  Data: Hypersensitivity reactions to contrast media are infrequent and can occur either within the first 60 min following their intravascular administration (immediate reactions) or at a later time point (non-immediate reactions). Most hypersensitivity reactions are mild or moderate, while severe reactions are rare (less than 1 in every 10,000 administrations). After any moderate or severe immediate adverse reaction, serum tryptase must be measured within 1–4 h from the onset of symptoms and at least 24 h after symptoms have disappeared to confirm a hypersensitivity reaction. At least for all moderate-to-severe hypersensitivity reactions, the patient should be referred to a drug allergy specialist for an allergy evaluation with a panel of contrast media, and optionally, all hypersensitivity reactions when local drug allergy specialist capacity allows. Selecting an alternative contrast medium based on practical experience is challenging due to its high and variable cross-reactivity; therefore, the best option is to choose an alternative based on the results of an allergy evaluation. This approach is safer and more effective than premedication for preventing recurrent hypersensitivity reactions. Key Points: QuestionWhat is the optimal strategy in clinical practice to prevent recurrent hypersensitivity reactions in adults who previously experienced a hypersensitivity reaction to contrast media? FindingsSerum tryptase should be measured within 1–4 h after a moderate or severe reaction, and at least all moderate or severe hypersensitivity reactions should be referred to an allergologist. Clinical relevanceManagement strategies should be adapted to the type and severity of the reaction, as well as the urgency of required re-administration. Changing from the culprit contrast agent to another molecule with differing side-chains is more effective than premedication. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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