Contrast Reactions- Classification and Pretreatment

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Enter the category for this item: Classification

Classification of Contrast Reactions


Allergies to Iodinated or Gadolinium based contrast agents are pretreated in the same manner and can be classified into the following categories-

Mild- Pretreatment not necessary for the following symptoms-

Limited urticaria/ pruritus
Limited cutaneous edema
Limited "itchy"/ "scratchy" throat
Nasal congestion
Sneezing
Conjunctivitis
Rhinorrhea
Limited nausea/ vomiting
Transient flushing/ warmth/ chills
Headache
Dizziness
Anxiety
Altered taste
Mild hypertension
Vasovagal reaction that resolves spontaneously

Moderate- Pretreat for the following symptoms-

Diffuse urticaria/ pruritis
Diffuse erythema, stable vital signs
Facial edema without dyspnea
Throat tightness or hoarseness without dyspnea
Wheezing/ bronchospasm, mild or no hypoxia
Protracted nausea/ vomiting
Hypertensive urgency
Isolated chest pain
Vasovagal reaction that requires and is responsive to treatment

Severe- Do not give contrast if there is a history of the following symptoms-

Diffuse edema, or facial edema with dyspnea
Diffuse erythema with hypotension
Laryngeal edema with stridor and/ or hypoxia
Wheezing/ bronchospasm, significant hypoxia
Anaphylactic shock (hypotension and tachycardia)
Vasovagal reaction resistant to treatment
Arrhythmia
Convulsions or seizures
Hypertensive emergency
Enter the category for this item: Pediatric Patients

Pretreatment in Pediatric Patients

Standard Pretreatment

Prednisone 0.7 mg/kg (not to exceed 50 mg) PO 13, 7 and 1 hr prior to injection.
Benadryl 1 mg/kg (not to exceed 50 mg) IV or PO within 1 hr prior to injection.

Emergent pretreatment

Hydrocortisone 1 mg/kg (not to exceed 200 mg) IV 4 hours prior to injection.
Benadryl 1 mg/kg (not to exceed 50 mg) IV or PO within 1 hr prior to injection.
Enter the category for this item: Adult Patients

Pretreatment in Adult Patients


Standard Pretreatment

Prednisone 50 mg PO 13, 7 and 1 hr prior to injection.
Benadryl 50 mg IV or PO within 1 hr prior to injection.

Emergent pretreatment

Hydrocortisone 200 mg IV 4 hours prior to injection.
Benadryl 50 mg IV or PO within 1 hr prior to injection.