Classification of Acute Contrast Reactions

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What are the categories of acute adverse reaction to contrast agents?

Allergic-like reactions, rather than true allergies, are seen with radiographic contrast administration and are referred to as anaphylactoid reactions. These are not true hypersensitivity reactions, and immunoglobulin E (IgE) antibodies are not involved. The clinical manifestations may be similar to allergic reactions (such as hives or bronchospasm), but these reactions are often idiosyncratic and prior sensitization is not required, unlike with true allergies. These reactions are independent of the dose and concentration of the contrast agent. A history of prior allergic-like contrast reaction may indicate the need for corticosteroid premedication prior to future contrast-enhanced studies that utilize a similar contrast agent.

Physiologic reactions to contrast agents are associated with the dose, molecular toxicity, and physical and chemical characteristics of the contrast agent. A history of a prior physiologic contrast reaction does not indicate the need for future corticosteroid premedication.

Classification of Acute Contrast Reactions

SEVERITYALLERGIC-LIKEPHYSIOLOGIC
Mild: self-limited symptoms and signsLimited urticaria/pruritusLimited nausea/vomiting
Limited cutaneous edemaTransient flushing/warmth/chills
Limited “itchy”/“scratchy” throatHeadache/dizziness/anxiety/altered taste
Nasal congestionMild hypertension
Sneezing/conjunctivitis/rhinorrheaVasovagal reaction that resolves spontaneously
Moderate: more pronounced symptoms and signs, potentially becoming severe if untreatedDiffuse urticaria/pruritusProtracted nausea/vomiting
Diffuse erythema, stable vital signsHypertensive urgency
Facial edema without dyspneaIsolated chest pain
Throat tightness or hoarseness without dyspneaVasovagal reaction that requires and is responsive to treatment
Wheezing/bronchospasm, mild or no hypoxia
Severe: often life-threatening, potentially resulting in permanent morbidity or death if not managed appropriatelyDiffuse edema, or facial edema with dyspneaVasovagal reaction resistant to treatment
Diffuse erythema with hypotensionArrhythmia
Laryngeal edema with stridor and/or hypoxiaConvulsions, seizures
Wheezing/bronchospasm, significant hypoxiaHypertensive emergency
Anaphylactic shock (hypotension and tachycardia)Pulmonary edema
Cardiopulmonary arrest
Pulmonary edema
Cardiopulmonary arrest

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