Pharmacological Prevention of Hypersensitivity Reactions Caused by Iodinated Contrast Media: A Systematic Review and Meta-Analysis

Objectives: Hypersensitivity reactions (HSRs) are uncommon but serious adverse events following the administration of iodinated contrast media (ICM) prior to CT imaging. While premedication is almost universally given in high-risk patients, there is a lack of evidence regarding the efficacy of such premedication. This study aims to determine the efficacy of premedication with corticosteroids prior to ICM administration in the prevention of HSRs through meta-analysis. Materials and Methods: An extensive review of the literature yielded 404 potentially relevant studies. Of these, five studies met the inclusion criteria of this meta-analysis. Pooled HSR event rates were obtained from each of the studies for both patients who had and who had not received premedication with corticosteroids. Heterogeneity between studies was also determined. Results: A total of 736 patients across all five studies were included in the analysis. Patients who did not receive premedication had initial pooled HSR rates of 0.16 (95% CI, 0.07–0.35) across all studies. Following premedication, pooled HSR rates dropped to 0.02 (95% CI, 0.01–0.06). Patients who had prior HSRs were significantly less likely to experience HSRs (OR = 0.09; 95% CI, 0.03–0.25; p < 0.00001) after treatment with premedication. Conclusions: This meta-analysis offers evidence for the reduction in the recurrence of moderate and severe HSRs in patients who have a history of such reactions. Premedication with corticosteroids prior to ICM administration is thus highly recommended in high-risk patients.