Iodinated contrast media allergy is rare in patients undergoing sialography

Chen Nadler,¹ Andra Rettman,¹ Nufar Benvenisty,¹ Yaarit Ribak,² Alon Y. Hershko,² Yuval Tal²

Affiliations:
¹ Maxillofacial Imaging, Department of Oral Medicine, School of Dental Medicine
² Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Abstract

Background: Iodinated contrast media allergy is considered as a strong contra-indication for performing sialography. There is little evidence to support this approach.
Objective: To evaluate the rate of iodinated contrast media (ICM) allergy in subjects undergoing sialography and to assess the risk for allergic responses in patients with a previous diagnosis of allergy.
Methods: We retrospectively reviewed sialo-CBCT studies performed from 2014 to 2019. During the study period we implemented a protocol for performing sialo-CBCT in patients with a prior diagnosis of allergy: 1) Clinical data were collected from a questionnaire and medical records. 2) No premedication was administered but, instead, oxygen, epinephrine and a resuscitation cart were accessible. 3) Following the procedure, each patient was observed for one hour and contacted by telephone 24 hrs later.
Results: No allergic responses were documented in the medical records of 1515 subjects following sialo-CBCT studies, including 13 individuals previously diagnosed with ICM allergy. Investigation of the subgroup with prior allergy disclosed that the range of injected volume was between 2 ml to 6.2 ml per patient and that complete secretion of ICM was detected in 7 of 13 patients. In the remainder of subjects, retention rates of 5-50% were observed.
Conclusions: Allergic reactions are exceedingly rare following sialo-CBCT studies regardless of a previous diagnosis of allergy. Pre-medication with corticosteroids and antihistamines is usually not warranted.
Key words: iodinated contrast media, drug hypersensitivity, sialography, iodine allergy, salivary glands,