“Steroid premedication in patients with a history of hypersensitivity can increase blood sugar, especially in diabetic patients. Trending issues on the use of gadolinium in diagnostic radiologic and IP [interventional pain] procedures include nephrogenic systemic fibrosis in patients with renal insufficiency and gadolinium brain deposition and retention,” said Honorio Benzon, MD, a professor of anesthesiology at Northwestern University Feinberg School of Medicine, in Chicago.

“The possibility of breakthrough reaction in patients given extravascular iodinated contrast media is low. Referral for preliminary testing partly depends on the nature of the reaction. A multispecialty practice advisory recommended an allergist for patients with moderate to severe hypersensitivity. However, there are not enough allergists to perform these tests in community hospitals,” Benzon, who was not involved with the study, noted.

“The primary limitation of our study was results obtained with this protocol are not generalizable and cannot be directly extrapolated to other radiologic procedures,” Kuruvilla said. “Most radiologic procedures require intravascular administration of contrast at higher doses. Our challenge dose of 5 mL was based on the fact that most IP procedures require an ICM volume of 1.5 to 3 mL. This does not rule out allergic reaction with higher doses of iodinated contrast.”