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Allergic-like reactions to intravenous contrast media containing gadolinium are rare in children and adults, according to a report in the December American Journal of Radiology.

"Despite recent publicity regarding nephrogenic systemic fibrosis (NSF), the results of our investigation confirm that gadolinium-containing contrast agents can be administered safely in the overwhelming majority of patients," Dr. Jonathan R. Dillman from University of Michigan Health System, Ann Arbor, told Reuters Health. "In the setting of severe renal insufficiency, however, such agents should be used with great caution due to the possibility of NSF."

Dr. Dillman and colleagues investigated the frequency and severity of acute allergic-like reactions to IV administration of gadolinium-containing contrast media in adults and children.

There were only 54 acute allergic-like reactions in more than 78,000 administrations of gadolinium-containing contrast media, the authors report, for an adult frequency of 0.07 per cent and a pediatric frequency of 0.04 per cent.

Most documented reactions were classified as mild (74 per cent), the report indicates, and only four (seven per cent) were classified as severe. There were no deaths related to administration of gadolinium-containing contrast media.

Half of the patients who experienced these reactions had one or more identifiable presumed risk factors for contrast reaction, the investigators say.

"While the fact that more women had allergic-like reactions to gadolinium-containing contrast agents than men did is interesting, this finding is of doubtful clinical significance due to only minimally increased overall risk (since the likelihood of an allergic-like reaction in both groups is extremely low)," Dr. Dillman explained.

"The frequency of acute allergic-like reaction to gadolinium-containing contrast media observed in our study is less than that typically observed for iodinated contrast media in adults," the researchers write. "In the pediatric population, the risk of allergic-like reaction to IV gadolinium-containing contrast media also appears to be less than that previously observed for iodinated contrast agents."

"We believe that all physicians and facilities administering such contrast materials should be judicious in their use and also be ready to treat such reactions promptly and appropriately, when necessary, upon their occurrence," Dr. Dillman said. "If the patient had previously experienced a moderate or severe reaction despite premedication, we would attempt to avoid future contrast injections (of like contrast materials) if at all possible.