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Differences in adverse drug reactions among seven iodinated contrast media

Published online: March 12, 2019

Globally, more than 70 million diagnostic radiographic studies use radiocontrast media each year. Although iodinated contrast media (ICM) are known to be relatively safe, the occurrences of mild and severe adverse drug reactions (ADRs) after the use of non-ionic low-osmolar contrast media are reported to be 3.1% and 0.04%, respectively. Although various studies have reported the occurrence of ADRs after ICM use, an understanding of whether the incidence of ADRs is affected by the type of ICM administered remains unaddressed. Knowledge of the occurrence rate and the severity of ADRs related to each individual ICM is essential to ensure patient safety.

In a recently published article in The Journal of Allergy and Clinical Immunology: In Practice, An et al. retrospectively reviewed 74,242 cases of causal ADRs due to ICM use from the Korea Adverse Event Reporting System (KAERS) database between January 2014 and December 2016. ADRs involving the following seven non-ionic ICM were considered: iohexol, iopamidol, iopromide, iomeprol, iobitridol, ioversol, and iodixanol. A total of 11,712,796 usage cases were identified, which represented all administrations of ICM reported from individual medical institutions. These data were obtained from the Health Insurance Review and Assessment Service. A proportionality test was used to examine the differences in the frequency ratio of causal ADRs to total usage cases.

It was observed that immediate hypersensitivity (44,467 cases, 88.6%) occurred more frequently than delayed hypersensitivity (5,725 cases, 11.4%). The overall occurrence rate of causal ADRs and serious ADRs considering total usage cases was 0.37% and 0.02%, respectively. The ICM that most commonly resulted in ADRs were iomeprol (0.7%) and iopromide (0.6%). Serious ADRs were most commonly reported for iomeprol (0.05%). When ADRs were classified by system organ class, “skin and appendages disorders” (47,065 cases, 63.4%) occurred most common. Furthermore, the highest frequency of “urinary system disorders” was seen for iodixanol.

Through comparison of the ADRs considering total usage cases, the incidence and classification of ADRs were observed to be different for each contrast medium. A prospective study is needed, as the differences in ADRs caused by these seven major contrast media may assist in the tailored selection of ICM for each patient.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.