Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis.

Radiology

From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.).

Published: August 2020

Background Hypersensitivity reactions to gadolinium-based contrast agents (GBCAs) that occur despite corticosteroid premedication (breakthrough reactions) are not well understood. Purpose To determine the GBCA breakthrough reaction rate overall and according to GBCA class and to determine the effect of using an alternative GBCA or allergy skin testing on the risk of a breakthrough reaction. Materials and Methods In this systematic review and meta-analysis, MEDLINE (from 1946 to 2019), Embase (from 1947 to 2019), and the Cochrane Central Register of Controlled Trials (2019 only) were searched for patients with a breakthrough reaction to a GBCA who were undergoing repeat GBCA administration. Breakthrough reaction rates were determined with random-effects modeling and meta-regression. Secondary analyses of GBCA class, switching to an alternative GBCA, and allergy skin testing were assessed. Quality Assessment of Diagnostic Accuracy Studies 2 was used to determine risk of bias and applicability. Percentages are meta-regression results and do not directly reflect raw data. Results Of the 148 identified studies, 23 were included, encompassing 120 patients and 130 GBCA administrations. The overall breakthrough reaction rate was 39% (95% confidence interval [CI]: 30%, 49%; 37 of 103 administrations). Breakthrough reaction rates for macrocyclic (36%; 95% CI: 25%, 48%; 23 of 64 administrations) and protein-binding linear (31%; 95% CI: 1%, 94%; [one of seven administrations) GBCAs did not differ ( = .90). There were insufficient analyzable data for gadodiamide, gadoversetamide, and gadopentetate. Hypersensitivity reaction rate after switching GBCAs was 50% (95% CI: 21%, 79%; three of nine administrations) with and 71% (95% CI: 21%, 95%; four of five administrations) without corticosteroid premedication, which did not differ ( = .82 and = .17, respectively) from the observed rate when using corticosteroid premedication and the same GBCA (36%; 95% CI: 26%, 48%; 37 of 84 administrations). Hypersensitivity reaction rate after allergy skin testing (17%; 95% CI: 7%, 29%; zero of 21 studies) did not differ when compared with use of the same agent with corticosteroid premedication ( = .10). Meta-analysis limitations were the small number of patients and the high risk of bias. Conclusion Patients with a prior hypersensitivity reaction to a gadolinium-based contrast agent (GBCA) often had breakthrough reactions. The effect of switching to an alternative GBCA or using allergy skin testing to decrease reaction risk lacked enough available data for meaningful comparisons. © RSNA, 2020 See also the editorial by Prince in this issue.

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2020192855DOI Listing

Publication Analysis

Top Keywords

breakthrough reaction
24
corticosteroid premedication
16
reaction rate
16
allergy skin
16
skin testing
16
gadolinium-based contrast
12
reaction rates
12
alternative gbca
12
gbca allergy
12
hypersensitivity reaction
12

Similar Publications

Applications of innovative synthetic strategies in anticancer drug Discovery: The Driving Force of new chemical reactions.

Bioorg Med Chem Lett

January 2025

State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China; University of Chinese Academy of Sciences, Beijing 100049, China; School of Pharmaceutical Science and Technology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China. Electronic address:

The discovery of novel anticancer agents remains a critical goal in medicinal chemistry, with innovative synthetic methodologies playing a pivotal role in advancing this field. Recent breakthroughs in CH activation reactions, cyclization reactions, multicomponent reactions, cross-coupling reactions, and photo- and electro-catalytic reactions have enabled the efficient synthesis of new molecular scaffolds exhibiting potent biological activities, including anticancer properties. These methodologies have facilitated the functionalization of natural products, the modification of bioactive molecules, and the generation of entirely new compounds, many of which demonstrate strong antitumor activity.

View Article and Find Full Text PDF

Risk of SARS-CoV-2 infection and adverse outcomes among vaccinated patients with tuberculosis.

Public Health

January 2025

Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Institute of Medicine/Department of Nursing, Chung Shan Medical University, Taichung, Taiwan. Electronic address:

Objectives: Limited data are available to assess breakthrough SARS-CoV-2 infections, medical utilization, and mortality in patients with tuberculosis (TB). The aim of this study was to examine the risk of COVID-19 and severe outcomes in patients with TB between January 2020 and March 2022.

Study Design: US electronic medical records were used to identify TB and non-TB patients who completed the primary series of vaccination and had no prior COVID-19.

View Article and Find Full Text PDF

Contrast media, including iodinated contrast media and gadolinium-based contrast agents, are commonly administered pharmaceuticals with excellent safety profiles. However, a minority of the population may experience a hypersensitivity reaction following intravenous administration. Hypersensitivity reactions can be immediate or delayed, and range from mild, such as urticaria, to severe, including anaphylaxis.

View Article and Find Full Text PDF

Aziridines, characterized by their highly constrained three-membered nitrogen-containing heterocyclic ring system, serve as compelling synthetic intermediates for synthesizing numerous naturally occurring alkaloids and pharmaceuticals. The distinct ring strain arising from the geometric constraints of these sp-rich trigonal rings imparts high reactivity, thereby offering a wealth of intriguing synthetic opportunities. Recent advances in the chemistry and reactivity of aziridines have unveiled significant progress in preparing more complex heterocycles.

View Article and Find Full Text PDF

Mechanisms of Ferroptosis in bone disease: A new target for osteoporosis treatment.

Cell Signal

January 2025

Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin 300211, China; Tianjin Orthopedic Institute, Tianjin 300050, China; Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin 300050, China. Electronic address:

Osteoporosis (OP) is a common disease in the elderly, characterized by decreased bone strength, reduced bone density, and increased fracture risk. There are two clinical types of osteoporosis: primary osteoporosis and secondary osteoporosis. The most common form is postmenopausal osteoporosis, which is caused by decreased estrogen production after menopause.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!