Pearl #1: “Iodine allergies” don’t exist. Iodine is not the antigenic component. Most reactions to contrast are non-IgE mediated hypersensitivity reactions.
Pearl #2: The risk of contrast-induced acute kidney injury (AKI) is overstated. Patients who are considered high risk include those with recent AKI and those with eGFR <30. In these patients, give IV fluids.
Pearl #3: In addition to IV contrast, PO contrast should be considered in CT scans of patients with suspected complication of IBD (i.e. fistula) and post bowel-reconstructive surgery (i.e. anastomotic leak).
- ACR Committee on Drugs and Contrast Media. Gastrointestinal (GI) Contrast Media in Adults: Indications And Guidelines. In: ACR Manual on Contrast and Media. Version 2020. New York, VA: American College of Radiology; 2020:1-131.
- Min Jae Cha, Dong Yoon Kang, Whal Lee, Soon Ho Yoon, Young Hun Choi, Jun Soo Byun, Jongmin Lee, Yun-Hyeon Kim, Ki Seok Choo, Bum Sang Cho, Kyung Nyeo Jeon, Jae-Woo Jung, Hye-Ryun Kang. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients. (2019) Radiology. 293 (1): 117-124.
- Schabelman E, Witting M. The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. (2010) The Journal of emergency medicine. 39 (5): 701-7