What are the strategies to manage a patient who has a known hypersensitivity to iodinated contrast material?
Adverse reactions to iodinated contrast material range from nuisance side effects such as hives and emesis to potentially lethal reactions such as anaphylaxis and laryngeal edema. Patients with a history of even a minor hypersensitivity reaction to iodinated contrast material may be at increased risk for a severe reaction, and special precautions should be exercised when administering iodinated contrast material to these patients. Premedication of the patient with oral corticosteroids and the use of low-osmolar contrast agents may reduce the risk of minor reactions, but no randomized controlled clinical trials have shown that these protect against severe life-threatening adverse reactions to iodinated contrast material. Alternative contrast agents, such as gadolinium-based agents, CO 2 , or both, may be used in patients with a history of severe iodinated contrast material reactions. If iodinated contrast material must be used in a patient with a history of bronchospasm, laryngeal edema, or anaphylaxis, it may be prudent to have an anesthesiologist standing by.