Hypersensitivity reactions to gadolinium-based contrast agents

• Published in: Current opinion in allergy and clinical immunology Vol. 17; no. 4; p. 241
• Main Authors: Fok, Jie Shen, Smith, William B
• Format: Journal Article
• Language: English
• Published: United States 01.08.2017
• Subjects: Anaphylaxis - chemically induced; Anaphylaxis - diagnosis; Anaphylaxis - immunology; Anaphylaxis - prevention & control; Contrast Media - adverse effects; Contrast Media - therapeutic use; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - immunology; Drug Hypersensitivity - prevention & control; Gadolinium - adverse effects; Gadolinium - therapeutic use; Humans; Immunoglobulin E - immunology; Skin Tests - methods
• ISSN: 1473-6322
• DOI: 10.1097/ACI.0000000000000371

Gadolinium-based contrast agents (GBCAs) have been utilized since the late 1980s to enhance the diagnostic value of MRI studies. They are known to have excellent safety profile and serious adverse reactions are uncommon despite widespread global use. However, immediate hypersensitivity reactions are well described in the literature, with urticaria the most common manifestation. Anaphylaxis can occur, though fatality is extremely rare. This review explores the incidence of GBCA-related hypersensitivity reactions and highlights potential risk factors. Emerging evidence suggests that immediate hypersensitivity reactions to GBCAs can be IgE-mediated. Skin testing may be informative in confirmation of causality and revealing cross-reactivity patterns. GBCA hypersensitivity is infrequent but can be serious. Familiarity with management of acute hypersensitivity reactions may be lifesaving. Appropriate use of diagnostic testing can be used to guide future management of patients who have suffered from such reactions.