BackTable / VI / Podcast / Episode #168
Debunking Contrast Allergies
with Dr. Cullen Ruff
We talk with Dr. Cullen Ruff about common misconceptions when it comes to IV contrast and issues with the "contrast allergy", including ways we can improve patient care and clinical workflows by clarifying the true source of these reactions.
BackTable, LLC (Producer). (2021, November 26). Ep. 168 – Debunking Contrast Allergies [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Cullen Ruff
Dr. Cullen Ruff is a practicing diagnostic radiologist and associate professor in Virginia.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, diagnostic radiologist Dr. Cullen Ruff and our host Dr. Chris Beck discuss the research and patient education surrounding contrast allergies.
Dr. Cullen starts the episode by commenting on the history of contrast media, noting that the earlier ionic contrast agents are more allergenic than the more recent non-ionic ones. By knowing the time period during which many radiologists switched to non-ionic agents (around 1985), we can identify during a medical history which of these types caused a patient’s allergic reaction.
The doctors discuss current research, which shows that substituting for a different contrast media is more effective than giving steroid premedication and using the allergy-inducing contrast media. Unfortunately, many patients are unable to recall the year when they experienced their allergy or the name of the contrast agent given. This lack of information makes it difficult to administer a substitute contrast media to the patient.
To address these workflow inefficiencies, Dr. Cullen advocates for individualized patient education over specific contrast allergies. He believes that taking the time to discuss allergies and giving the patient the name of their allergen, in writing, is essential for future imaging studies. He advises against the use of the vague and nonsensical term of “iodine allergy”, noting that patients are never allergic to the iodine itself, but rather a different component in the iodinated contrast media.
Finally, we discuss Dr. Cullen’s book, “Looking Within: Understanding Ourselves Through Human Imaging” in which he shares patient stories and introduces the general public to the retrospective and predictive values of diagnostic imaging.
“Patients Have a Very Limited Knowledge of Their Contrast Allergies”:
“Prevention of Allergic-like Reactions at Repeat CT: Steroid Pretreatment versus Contrast Material Substitution”:
“Iodine Allergy: Common Misperceptions”:
American College of Radiology Manual on Contrast Media, 2021:
Dr. Cullen’s book, “Looking Within: Understanding Ourselves Through Human Imaging”:
“The Immunology of the Vermiform Appendix: A Review of the Literature”:
[Dr. Christopher Beck]:
Okay. So if we think iodine allergy should be removed, what should we be telling patients when they have an allergic reaction? So we'll go back to a scenario where a patient has an allergic reaction to a non-ionic or a recent contrast allergy, like during a CTA or whatever. What should we be telling that patient? Or what should we, as the physicians or some of the technologist, what should we be documenting?
[Dr. Cullen Ruff]:
The first thing you document is the actual contrast agent given by name, just like you would any antihypertensive or any antibiotic or any other drug that a patient has an allergic reaction to because what's most important is the next time this person needs a contrast injection, you can give them something different. We'll use penicillin G as the rogue antibiotic example here, if someone's allergic to penicillin G, and they need an antibiotic, what makes more sense to you: to give them the antibiotic that they're allergic to plus steroids to premedicate or does it simply make more sense to give them a different antibiotic that they've never had? And that's what we're going to discuss here. That's the same thing when it comes to contrast, we have to know by name what people have reacted to so that we can give them something different because giving people a different agent is the best way to prevent a future reaction much more so than steroid pre-medication.
[Dr. Christopher Beck]:
Another scenario, so if a patient has an allergic reaction and I'm going to use trade names as well, like Omnipaque 350, then if that patient comes back, having had a documented allergic reaction, you would recommend as the radiologists that, “Hey, let's try something different, like ISOVUE or Visipaque.” Is that right?
[Dr. Cullen Ruff]:
Absolutely. So ISOVUE, Visipaque, Optiray, Omnipaque, those are some of the most commonly used current low osmolar and lower allergenic agents. And yes, you would simply choose a different one.
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