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Overview
Radiology Comprehensive Contrast Policy University of Iowa 2013 (guideline as of 2013, based on the ACR Manual on Contrast Media 2012). See updated: https://www.acr.org/Clinical-Resources/Contrast-Manual
Previous Guideline from 2009
Standard preparation for patients with iodine allergy is:
- Current guideline: 50 mg prednisone po 13 hours before, 7 hours before, and 1 hour before the procedure. In addition, diphenhydramine 50 mg iv, im, or po 1 hour before the procedure, which supersedes the prior guideline of prednisone 40 mg by mouth at 12 hours and 2 hours prior to contrast injection.
- Some adverse reactions to iodinated contrast material are considered allergy-like, but systemic reactions, involving cutaneous, cardiovascular, respiratory and digestive systems are largely unpredictable (ref Liccardi 2008). Reactions to contrast media are more frequent with ionic than nonionic material. Iodinated contrast media have a favorable safety profile but the rate of adverse events (especially urticaria and bronchospasm) has been reported to be at least 0.7%.
References
Liccardi G, Lobefalo G, Di Florio E, Di Iorio C, Occhiochiuso L, Romano L, Savoia G, Massa RM, D'Amato G; Cardarelli Hospital Radiocontrast Media and Anesthetic-Induced Anaphylaxis Prevention Working Group. Strategies for the prevention of asthmatic, anaphylactic and anaphylactoid reactions during the administration of anesthetics and/or contrast media. J Investig Allergol Clin Immunol. 2008;18(1):1-11. PMID: 18361095.