Management of patients at high risk of hypersensitivity reactions to contrast agents undergoing examination with Iodinated Contrast Media (ICM)

Premedication in patients at high risk of an immediate hypersensitivity reaction to contrast remains controversial. This article aims to present a case report on a successful case of premedication in a patient with a history of anaphylactic reaction to contrast agents. This article reports a 60-year-old female patient with diagnosis of anterior bladder adenocarcinoma T3N0M0 and a history of anaphylactic reaction to contrast. The patient was planned by the urology department for another abdominal CT scan examination using contrast, and was consulted to allergy and immunology division a day before the abdominal CT scan was performed. The patient was given different contrasts and given a premedication using intraoral methylprednisolone 32 mg at 12-hours, and 2-hour before the procedure and intramuscular diphenhydramine 50 mg at 1-hour before the procedure. Patients' symptoms, vital signs, and allergic reactions were monitored during the procedure, and no adverse reactions occurred. Our finding highlights a successful prevention of hypersensitivity reactions in this case. American College of Radiology recommended strategic prevention for patients with history of hypersensitivity of reactions, but it has not proven effective in reducing moderate to severe hypersensitivity incident. Proper preparation must be done to prevent reactions in patients with a history of hypersensitivity reactions to contrast.