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. 2025 Oct;26(10):986-997.
doi: 10.3348/kjr.2025.0263.

Acute Adverse Reactions to Nonionic Low-Osmolar Iodinated Contrast Media in Children: A Retrospective Study of 23,429 Injections Over 6 Years

Yewon Seong  1 , Pyeong Hwa Kim  2 , Chong Hyun Suh  3 , Kye Jin Park  3 , Hyo Jung Park  3 , Choong Wook Lee  3 , Ah Young Jung  3 , Young Ah Cho  3 , Jin Seong Lee  3 , Hee Mang Yoon  3
Affiliations

Acute Adverse Reactions to Nonionic Low-Osmolar Iodinated Contrast Media in Children: A Retrospective Study of 23,429 Injections Over 6 Years

Yewon Seong et al. Korean J Radiol. 2025 Oct.

Abstract

Objective: To evaluate the incidence and risk factors of acute adverse drug reactions (ADRs) to nonionic low-osmolar iodinated contrast media (LOCM) in a pediatric population.

Materials and methods: This single-center retrospective study included consecutive data on nonionic LOCM injections in pediatric patients (≤18 years) between January 1, 2016, and June 30, 2023. The per-examination incidences of acute ADRs (physiologic and allergic-like reactions) were assessed along with their severities. Multivariable Poisson regression analysis with generalized estimating equations was used to explore the risk factors associated with the occurrence of each ADR type.

Results: Among 23,429 injections administered to 13,172 pediatric patients, acute allergic-like reactions occurred in 0.89% (208/23,429) of cases, most of which were mild (0.79%; 186/23,429). Acute physiologic reactions occurred in 0.55% (128/23,429), also predominantly mild (0.50%, 118/23,429). Both types of ADRs occurred slightly more frequently in older patients (allergic-like reactions: adjusted relative risk (RR) = 1.09 per 1-year increase [95% confidence interval {CI}: 1.06, 1.11], P < 0.001; physiologic reactions: adjusted RR = 1.04 per 1-year increase [95% CI: 1.01, 1.07], P = 0.008) and more frequently in those with a history of such reactions (allergic-like reactions = 3.62 [95% CI: 1.44, 9.09], P = 0.006; physiologic reactions = 7.44 [95% CI: 2.55, 21.70], P < 0.001). Acute allergic-like reactions occurred less frequently in inpatient/emergency settings than in outpatient settings (adjusted RR = 0.64 [95% CI: 0.48, 0.85], P = 0.002). Among the 226 examinations with prior allergic-like reactions, recurrent acute allergic-like reactions occurred in 7.26% (9/124) when re-exposed to the same generic LOCM and in 3.92% (4/102) when exposed to a different generic LOCM (P = 0.28). Moderate reactions occurred in three cases that were re-exposed to the same LOCM, whereas all four reactions with different LOCM were mild.

Conclusion: Acute allergic-like and physiologic reactions to nonionic LOCM occurred in 0.89% and 0.55% of cases, respectively. Older age and a history of prior reactions were significant risk factors. Particular care is warranted during contrast-enhanced CT in these high-risk groups.

Keywords: Adverse reaction; Contrast media; Iodinated contrast media; Pediatrics; Safety.

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Conflict of interest statement

Chong Hyun Suh, an Assistant to the Editor of the Korean Journal of Radiology, was not involved in the editorial evaluation or decision to publish this article. The remaining authors have declared no conflicts of interest.

Figures

Fig. 1
Fig. 1. Patient selection flowchart.
Fig. 2
Fig. 2. Bar graph depicting the incidence of acute allergic-like reactions associated with different iodinated contrast media. Values in parentheses indicate numerators and denominators, and values in brackets indicate the 95% confidence intervals of the corresponding proportions.
Fig. 3
Fig. 3. Bar graph illustrating the incidence of acute physiologic reactions associated with different iodinated contrast media. Values in parentheses indicate numerators and denominators, and values in brackets indicate the 95% confidence intervals of the corresponding proportions.
See this image and copyright information in PMC

References

    1. ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. [[accessed on October 25, 2024]]. Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Cont....
    1. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175:621–628. - PubMed
    1. McDonald JS, Larson NB, Schmitz JJ, Kolbe AB, Hunt CH, Hartman RP, et al. Acute adverse events after iodinated contrast agent administration of 359,977 injections: a single-center retrospective study. Mayo Clin Proc. 2023;98:1820–1830. - PubMed
    1. Callahan MJ, Poznauskis L, Zurakowski D, Taylor GA. Nonionic iodinated intravenous contrast material-related reactions: incidence in large urban children’s hospital--retrospective analysis of data in 12,494 patients. Radiology. 2009;250:674–681. - PubMed
    1. Cha MJ, Kang DY, Lee W, Yoon SH, Choi YH, Byun JS, et al. Hypersensitivity reactions to iodinated contrast media: a multicenter study of 196 081 patients. Radiology. 2019;293:117–124. - PubMed