Mexican College of Clinical Immunology and Allergy
Hypersensitivity to iodinated contrast media: Diagnostic and therapeutic strategies. Position Statement of the Drug Allergy Committee of the Mexican College of Clinical Immunology and Allergy
Hypersensitivity reactions to iodinated contrast media represent a relevant clinical issue due to their increasing use in radiodiagnostic procedures. These reactions are classified as immediate or non-immediate, immunological and non-immunological, with variable prevalence and potentially serious consequences such as anaphylaxis or severe cutaneous adverse reactions. Identifying risk factors, classification, and immunological mechanisms of iodinated contrast media enables the development of effective prevention and management strategies.
To analyze the chemical characteristics of iodinated contrast media, the associated immunological mechanisms, and available diagnostic tools to establish effective strategies for the prevention, diagnosis, and management of hypersensitivity reactions in both general and vulnerable populations.
A literature review was conducted analyzing the different types of contrast media according to their chemical structure, osmolarity, osmolality, and viscosity, highlighting their association with the risk of hypersensitivity reactions. The immunological mechanisms involved are described, including IgE-mediated responses, T-cell-mediated reactions, and activation of the MRGPRX2 receptor. Diagnostic tools such as in vivo, in vitro tests, and controlled exposure tests were examined in terms of sensitivity, specificity, and clinical utility. Cross-reactivity between iodinated contrast media agents and the usefulness of grouping them based on chemical characteristics to guide the selection of safer alternatives were addressed. Finally, therapeutic and preventive strategies were reviewed, including premedication protocols, iodinated contrast media selection, and special considerations for vulnerable populations such as pediatric patients, pregnant women, and older adults.
Hypersensitivity to iodinated contrast media requires a multidisciplinary diagnostic and therapeutic approach based on accurate characterization of the reaction, immunological assessment, and personalized selection of contrast agents. Current knowledge allows for a significant reduction in HSR recurrence through substitution of the culprit agent and/or appropriate premedication, thereby improving the safety of contrast-enhanced diagnostic procedures.
Las reacciones de hipersensibilidad a medios de contraste yodados representan un problema clínico relevante debido al uso creciente para estudios radiodiagnósticos. Estas reacciones se clasifican en inmunológicas inmediatas, no inmediatas y no inmunológicas, con una prevalencia variable y potenciales consecuencias graves (anafilaxia o reacciones adversas cutáneas graves). La identificación de factores de riesgo, clasificación y mecanismos inmunológicos de los medios de contraste permiten establecer estrategias de prevención y tratamiento.
Analizar las características químicas de los medios de contraste, mecanismos inmunológicos y métodos diagnósticos disponibles, con la finalidad de establecer estrategias efectivas para su prevención, diagnóstico y tratamiento en poblaciones generales y vulnerables.
Se efectuó una revisión bibliográfica donde se analizaron los diferentes tipos de medios de contraste, según su estructura química, osmolaridad, osmolalidad y viscosidad, destacando su asociación con el riesgo de reacciones de hipersensibilidad. Se describen los mecanismos inmunológicos implicados, incluyendo respuestas mediadas por IgE, células T y el receptor MRGPRX2. Se detallan métodos diagnósticos: estudios in vivo e in vitro, y prueba de exposición controlada, evaluando la sensibilidad, especificidad y utilidad clínica. Se puntualiza la reactividad cruzada entre medios de contraste y la utilidad de agruparlos según sus características químicas para elegir alternativas seguras. Finalmente, se abordan estrategias terapéuticas y preventivas, como la premedicación, la selección del medio de contraste y las consideraciones especiales en poblaciones vulnerables (pacientes pediátricos, mujeres embarazadas y adultos mayores).
La hipersensibilidad a medios de contraste requiere un enfoque diagnóstico y terapéutico multidisciplinario, basado en la adecuada caracterización de la reacción, estudios inmunológicos y selección personalizada del medio de contraste que de administrará. El conocimiento actual permite reducir significativamente la recurrencia de reacciones de hipersensibilidad mediante la sustitución del agente implicado y/o premedicación, optimizando así la seguridad de los procedimientos diagnósticos asociados con medios de contraste.
Source and rights
Published by Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993), 2026. The PDF is shown as published and remains the work of its authors and publisher; the original is at the source linked here. Rights holders can ask us to remove a file at info@prognia.nl.
Prognia summarises this guideline for reference and education. It is not medical advice. Always check the official guideline and current local protocols before acting on it.
At a glance
Organisation
Mexican College of Clinical Immunology and Allergy
Published
2026
Applies to
🇲🇽 Mexico
Scope
National
Journal
Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)
The 2026 British Society for Rheumatology guideline for pain management in people with inflammatory arthritisBritish Society for Rheumatology · 2026PDF
