Pre Medication Contrast Policy

* Patients who have had severe allergic reactions to allergens other than iodinated contrast but who have previously received iodinated contrast without premedication and without incident, do not need to be pre-medicated.

** A patient with a well-documented history of a severe reaction to a contrast agent (oral or intravenous) should not receive the same contrast (oral or IV) unless, in the opinion of the responsible health care professional and supervising radiologist, the potential benefits outweigh the potential risks, such as in an emergency situation. In these instances, specific indications and reason(s) for exception should be documented in report.

*** With contrast of same type planned to be given. If the patient has received the same IV contrast in the past without an adverse event, then pre-medication may be omitted.

This policy decision is based on the following information:

• Current estimated reaction risk in the general population is about 0.6% (Wang et al.)
• Only patients with a prior reaction to contrast are known to be at higher risk (3-11% reaction rate, with 2% break-through) (Mervak et al.Lasser et al).
• The rate of reaction for patients with prior anaphylaxis to substances other then contrast may be higher than the normal population, but this is not proven.
• The current standard of care in the United States is to premedicate patients with steroids and Benadryl to decrease risk of repeat contrast reaction in patients who have had a reaction in the past to a similar class contrast agent.

References:

Wang CL, Cohan RH, Ellis JH, Caoili EM, Wang G, Francis IR. Frequency, outcome, and appropriateness of treatment of nonionic contrast media reactions. AJR 2008; 191:409–415

Lasser EC, Berry CC, Mishkin MM, Williamson B, Zheutlin N, Silverman JM. Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. AJR 1994; 162:523–526

Mervak BM, Davenport MS, Ellis JH, et al. Breakthrough reaction rates in high-risk inpatients premedicated before contrast-enhanced CT. AJR 2015 (jn press)

* Patients who have had severe allergic reactions to allergens other than iodinated contrast but who have previously received iodinated contrast without premedication and without incident, do not need to be premedicated.

** A patient with a well-documented history of a severe reaction to a contrast agent (oral or intravenous) should not receive the same contrast (oral or IV) unless, in the opinion of the responsible health care professional and supervising radiologist, the potential benefits outweigh the potential risks, such as in an emergency situation. In these instances, specific indications and reason(s) for exception should be documented in report.

*** With contrast of same type planned to be given. If the patient has received the same IV contrast in the past without an adverse event, then pre-medication may be omitted.