Optimizing Premedication Strategies for Iodinated Contrast Media in CT scans: A Literature Review

Abstract

Background

Computed tomography (CT) has revolutionized medical imaging, enabling cross-sectional evaluation of the human body. The increasing utilization of iodinated contrast media (ICM) in contrast-enhanced CT scans has raised concerns about potential adverse reactions. This literature review investigates the efficacy of premedication regimens in preventing severe allergic reactions to intravenous ICM. The study explores the ongoing debate between premedication and the use of alternative contrast agents, such as low-osmolarity contrast media (LOCM). Also, it evaluates the potential role of orally administered steroids in reducing breakthrough reactions.

Methods

This study conducted a literature review to identify the most effective premedication regimens for preventing severe hypersensitivity reactions to intravenous ICM. Searches were performed across multiple databases, focusing on peer-reviewed articles written in English and published after 2010. A total of 10 articles were selected based on strict inclusion criteria, and their findings were summarized and analyzed.

Results

The review identified that premedication with corticosteroids and antihistamines can significantly reduce the likelihood of hypersensitivity reactions in patients with a history of allergic reactions to ICM. However, the effectiveness of premedication in completely preventing reactions is limited, with breakthrough reactions still occurring. Studies also highlighted that switching to non-ionic low-osmolarity contrast media (LOCM) may offer a more substantial reduction in hypersensitivity reactions compared to premedication alone, although cost and availability constraints limit its widespread use.

Conclusion

Premedication with corticosteroids and antihistamines is beneficial in reducing hypersensitivity reactions to ICM, but its effectiveness is not absolute. Switching to LOCM may further reduce the risk, though practical limitations exist. The combination of premedication and changing the type of ICM may offer a more comprehensive approach. Further research is needed to refine premedication strategies, particularly in diverse patient populations, and to understand the impact of scan-related factors on allergic reactions.