Subsequent MRI of pediatric patients after an adverse reaction to Gadolinium-based contrast agents.

Azadeh Hojreh,Aleksandra Bundalo,Zsolt Szepfalusi,Andreas Peyrl,Xi Chen

doi:10.1371/journal.pone.0230781

Azadeh Hojreh, Aleksandra Bundalo + Show 3 more

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https://doi.org/10.1371/journal.pone.0230781

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Journal: PloS one	Publication Date: Apr 3, 2020
Citations: 8	License type: CC BY 4.0

Affiliation: Medical University of Vienna

Abstract

BackgroundGadolinium-based contrast agent (GBCA)-enhanced magnetic resonance imaging (MRI) scans often must be used repeatedly in pediatric oncologic patients. Although GBCAs are usually well tolerated, severe and life-threatening allergic reactions might occur, which can result in overly cautions adherence to special precautions in patients.PurposeTo evaluate the management of the reported GBCA-associated adverse reactions in subsequent contrast-enhanced MRIs in pediatric patients, distinguishing non-allergic and allergic reactions.Materials and methodsIn this retrospective, cross-sectional study, consecutive pediatric neurooncological patients who underwent GBCA-enhanced MRI at our university hospital, between 2007 and 2016, were eligible. The patients’ history was evaluated with regard to any adverse events after GBCA administration. In a subset of patients with reported adverse reactions, the institutional premedication regime or an allergy work-up in clinical practice were performed, using either skin-prick tests or intravenous provocation tests in a double-blind procedure.ResultsIncluded were 8156 contrast-enhanced MRI scans in 2109 patients. Nineteen acute adverse events (19/8156; 0.23%) in 17 patients (17/2109; 0.81%) were reported. Despite a premedication regime in 14 patients, three patients (3/14; 21.4%) reported a breakthrough reaction. None of the 12 patients who underwent skin-prick tests or intravenous provocation tests showed allergic reactions. At least one well-tolerated GBCA was identified in almost every tested patient.ConclusionA fast-track allergy work-up can help to distinguish non-allergic and allergic reactions and to identify a well-tolerated GBCA, thus avoiding unnecessary premedication for subsequent GBCA administrations.

Highlights

Repeated Gadolinium-based contrast agent (GBCA)-enhanced Magnetic resonance imaging (MRI) examinations are frequently required in the diagnosis and follow-up of pediatric patients, especially in patients with central nervous system (CNS) tumors, which constitute the largest group of solid neoplasms in children [1, 2]
Such reactions can be categorized as either allergic-like hypersensitivity or chemotoxic responses [4], and are classified either into four grades according to the Ring and Messmer classification [5], or into three categories of severity according to the American College of Radiology (ACR) Committee on Drugs and Contrast Media [3] or according to the European Society of Urogenital Radiology (ESUR) guidelines on contrast agents [4]
In our patient collective with reported GBCA-associated adverse events, there was no confirmed allergic reaction to GBCA, either with skin-prick tests or with intravenous provocation tests, the 0.23% incidence of GBCA-associated adverse events in our study was within the range of the published incidences in earlier pediatric studies, where an adverse reaction frequency of 0.04% - 19.3% was reported [21,22,23]

Summary

Introduction

Repeated Gadolinium-based contrast agent (GBCA)-enhanced Magnetic resonance imaging (MRI) examinations are frequently required in the diagnosis and follow-up of pediatric patients, especially in patients with central nervous system (CNS) tumors, which constitute the largest group of solid neoplasms in children [1, 2].GBCAs have been approved for parenteral use since the late 1980s and are extremely well tolerated by the vast majority of patients [3]. The incidence of acute adverse reactions is lower than that observed after the administration of iodinated contrast media [3]. Such reactions can be categorized as either allergic-like hypersensitivity or chemotoxic responses [4], and are classified either into four grades according to the Ring and Messmer classification [5], or into three categories of severity (mild, moderate, or severe) according to the American College of Radiology (ACR) Committee on Drugs and Contrast Media [3] or according to the European Society of Urogenital Radiology (ESUR) guidelines on contrast agents [4].

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