Allergy to the iodinated contrast media – the clinical and immunological aspects – a literature review




allergy, contrast, adverse drug reaction


Aim. The aim of this paper is to analyse and review the currently available evidence and research with regard to allergy to the iodinated contrast media, which still remains an important, albeit rare, clinical complication.

Material and Methods. We performed our research using the PubMed search engine provided by the National Centre for Biotechnology Information, having inserted ‘iodinated contrast media’, ‘allergy’, ‘adverse reactions’ as the keywords.

Results. Even though the modern iodinated contrast media are much safer than those used in the past, adverse reactions still occur in up to 1–3% of patients undergoing radiological procedures. Their range varies from skin changes, such as a macular rash, prurigo or urticarial, to the more severe multisystemic reactions including anaphylactic shock. The underlying mechanisms are still investigated and are not fully comprehended, although the most frequently accepted explanations include a systemic inflammatory reaction associated with increased histamine and tryptase levels, activation of memory T cells and both direct and indirect damage to the vascular epithelium. The significance of classic allergy tests has not yet been fully established. The associated known risk factors are of various character and researchers have come with different, occasionally contradicting results regarding patients’ age and gender, however, other factors have been more clearly described, and include concomitant conditions and medications.

Conclusions. The aforementioned data emphasizes the importance of clinical aspects of allergy to the iodinated contrast media for every practicing physician, as more and more medical specialties benefit from the advantages of modern vascular imaging.


Download data is not yet available.

Author Biographies

Dorota Jenerowicz, Department and Clinic of Dermatology, Poznan University of Medical Sciences, Poland


Edict2 Kanjidic No entry found Add Flashcard    

Zygmunt Adamski, Department and Clinic of Dermatology, Poznan University of Medical Sciences, Poland


Edict2 Kanjidic No entry found Add Flashcard    

Magdalena Czarnecka-Operacz, Department and Clinic of Dermatology, Poznan University of Medical Sciences, Poland


Edict2 Kanjidic No entry found Add Flashcard    


Pelewicz K, Miśkiewicz P. Iodinated contrast media-induced hyperthyroidism. JMS [Internet]. 2020 Jun 30;89(2):e439. doi:10.20883/medical.e439

Brockow K, Christiansen C, Kanny G, Clément O, Barbaud A, Bircher A, Dewachter P, Guéant JL, Rodriguez Guéant RM, Mouton-Faivre C, Ring J, Romano A, Sainte-Laudy J, Demoly P, Pichler WJ; ENDA; EAACI interest group on drug hypersensitivity. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005 Feb;60(2):150-8. doi: 10.1111/j.1398-9995.2005.00745.x. PMID: 15647034.

Brasch RC. Allergic reactions to contrast media: accumulated evidence. AJR Am J Roentgenol. 1980 Apr;134(4):797-801. doi: 10.2214/ajr.134.4.797. PMID: 6767368.

Lieberman P. Anaphylactoid reactions to radiocontrast material. Clin Rev Allergy. 1991 Fall-Winter;9(3-4):319-38. doi: 10.1007/BF02802311. PMID: 1723654.

Christiansen C. X-ray contrast media--an overview. Toxicology. 2005 Apr 15;209(2):185-7. doi: 10.1016/j.tox.2004.12.020. PMID: 15767033.

Mita H, Tadokoro K, Akiyama K. Detection of IgE antibody to a radiocontrast medium. Allergy. 1998 Dec;53(12):1133-40. doi: 10.1111/j.1398-9995.1998.tb03832.x. PMID: 9930588.

Morcos SK, Thomsen HS. Adverse reactions to iodinated contrast media. Eur Radiol. 2001;11(7):1267-75. doi: 10.1007/s003300000729. PMID: 11471623.

Lang D.M., Alpern M.B., Visintainer P.F., Smith S.T.: Increased Risk for Anaphylactoid Reaction from Contrast Media in Patients on β-Adrenergic Blockers or with Asthma. Ann. Intern. Med. 1991 Aug;155(4):270-276. doi: 10.7326/0003-4819-115-4-270

Bettmann M.A., Heeren T., Greenfield A., Goudey C.: Adverse events with radiographic contrast agents: results of the SCVIR Contrast Agent Registry. Radiology 1997 203:3, 611-620. Doi: 10.1148/radiology.203.3.9169677

Beckett K.R., Moriarity A.K, Langer J.M.: Safe Use of Contrast Media: What the Radiologist Needs to Know. RadioGraphics 2015 35:6, 1738-1750. Doi:

Mygind N, Dahl R, Pedersen S, Thestrup-Pedersen K: Alergologia, red. Kruszewski J i Silny W, Urban & Partner, 1998.

Christiansen C, Pichler WJ, Skotland T. Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations. Eur Radiol. 2000;10(12):1965-75. doi: 10.1007/s003300000543. PMID: 11305580.

Lerch M, Keller M, Britschgi M, Kanny G, Tache V, Schmid DA, Beeler A, Gerber BO, Luethi M, Bircher AJ, Christiansen C, Pichler WJ. Cross-reactivity patterns of T cells specific for iodinated contrast media. J Allergy Clin Immunol. 2007 Jun;119(6):1529-36. doi: 10.1016/j.jaci.2007.02.007. Epub 2007 Apr 6. PMID: 17412404.

Mauri-Hellweg D, Bettens F, Mauri D, Brander C, Hunziker T, Pichler WJ. Activation of drug-specific CD4+ and CD8+ T cells in individuals allergic to sulfonamides, phenytoin, and carbamazepine. J Immunol. 1995 Jul 1;155(1):462-72. PMID: 7602118.

Eggers AE, Hibbard CA. Direct cell-mediated cytotoxicity in experimental allergic encephalomyelitis. J Neurol Sci. 1981 Jan;49(1):109-16. doi: 10.1016/0022-510x(81)90193-3. PMID: 6162919.

Webb JA, Stacul F, Thomsen HS, Morcos SK; Members Of The Contrast Media Safety Committee Of The European Society Of Urogenital Radiology. Late adverse reactions to intravascular iodinated contrast media. Eur Radiol. 2003 Jan;13(1):181-4. doi: 10.1007/s00330-002-1650-5. Epub 2002 Sep 10. PMID: 12541128.

Mikami C, Ochiai K, Kagami M, Tomioka H, Tanabe E. In vitro interleukin-5 (IL-5) production by peripheral blood mononuclear cells from patients with drug hypersensitivity. J Dermatol. 1996 Jun;23(6):379-81. PMID: 8708148.

Plavsić B, Kuzmanić D, Rotkvić I. Eosinophilia caused by iodinated radiographic contrast media. Clin Radiol. 1983 Nov;34(6):639-42. doi: 10.1016/s0009-9260(83)80412-7. PMID: 6689519.

Vincent ME, Gerzof SG, Robbins AH. Benign transient eosinophilia following intravenous urography. JAMA. 1977 Jun 13;237(24):2629. PMID: 576988.

Böhm I, Speck U, Schild H. A possible role for cysteinyl-leukotrienes in non-ionic contrast media induced adverse reactions. Eur J Radiol. 2005 Sep;55(3):431-6. doi: 10.1016/j.ejrad.2005.01.007. PMID: 16129253.

Idée JM, Pinès E, Prigent P, Corot C. Allergy-like reactions to iodinated contrast agents. A critical analysis. Fundam Clin Pharmacol. 2005 Jun;19(3):263-81. doi: 10.1111/j.1472-8206.2005.00326.x. PMID: 15910651.

Laroche D, Aimone-Gastin I, Dubois F, Huet H, Gérard P, Vergnaud MC, Mouton-Faivre C, Guéant JL, Laxenaire MC, Bricard H. Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology. 1998 Oct;209(1):183-90. doi: 10.1148/radiology.209.1.9769830. PMID: 9769830.

Laroche D, Vergnaud MC, Lefrançois C, Hue S, Bricard H. Anaphylactoid reactions to iodinated contrast media. Acad Radiol. 2002 Aug;9 Suppl 2:S431-2. doi: 10.1016/s1076-6332(03)80253-2. PMID: 12188298.

Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977 Feb 26;1(8009):466-9. doi: 10.1016/s0140-6736(77)91953-5. PMID: 65572.

Kim MH, Lee SY, Lee SE, Yang MS, Jung JW, Park CM, Lee W, Cho SH, Kang HR. Anaphylaxis to iodinated contrast media: clinical characteristics related with development of anaphylactic shock. PLoS One. 2014 Jun 16;9(6):e100154. doi: 10.1371/journal.pone.0100154. PMID: 24932635; PMCID: PMC4059752.

Thomsen HS, Morcos SK; Contrast Media Safety Committee of European Society of Urogenital Radiology. Management of acute adverse reactions to contrast media. Eur Radiol. 2004 Mar;14(3):476-81. doi: 10.1007/s00330-003-2214-z. Epub 2004 Jan 23. PMID: 14740165.

Vernassiere C, Trechot P, Commun N, Schmutz JL, Barbaud A. Low negative predictive value of skin tests in investigating delayed reactions to radio-contrast media. Contact Dermatitis. 2004 Jun;50(6):359-66. doi: 10.1111/j.0105-1873.2004.00367.x. PMID: 15274727.

Stellato C, de Crescenzo G, Patella V, Mastronardi P, Mazzarella B, Marone G. Human basophil/mast cell releasability. XI. Heterogeneity of the effects of contrast media on mediator release. J Allergy Clin Immunol. 1996 Mar;97(3):838-50. doi: 10.1016/s0091-6749(96)80162-x. PMID: 8613641.

Peachell PT, Morcos SK. Effect of radiographic contrast media on histamine release from human mast cells and basophils. Br J Radiol. 1998 Jan;71(841):24-30. doi: 10.1259/bjr.71.841.9534695. PMID: 9534695.

Mansi IA. In vitro effects of coronary angiography: unknown clinical implications. Med Hypotheses. 2009 Sep;73(3):389-92. doi: 10.1016/j.mehy.2009.02.035. Epub 2009 May 5. PMID: 19409722.

Soar, J., Deakin, C. D., Nolan, J. P., Perkins, G. D., Yeung, J., Couper, K., Hall, M., Thorne, C., Price, S., Lockey, A., Wyllie, J., & Hampshire, S. (2021). Adult advanced life support guidelines. Resuscitation Council UK.




How to Cite

Jenerowicz D, Kanabaj K, Adamski Z, Czarnecka-Operacz M. Allergy to the iodinated contrast media – the clinical and immunological aspects – a literature review. JMS [Internet]. 2022 Mar. 31 [cited 2023 Dec. 11];91(1):e593. Available from:



Review Papers
Received 2021-11-30
Accepted 2022-03-31
Published 2022-03-31