Allergies to IV Contrast Dye

In This Article

Intravenous (IV) dye, which is contrast dye given through the vein—also known as radiocontrast media (RCM)—is used widely in the United States for various radiological studies, such as angiograms, X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans. Adverse reactions to RCM are fairly common, though allergies are rarer.

You may be surprised to learn that allergic reactions to RCM are not truly allergic in nature, meaning that there is no allergic antibody present that causes the reaction. Rather, RCM acts to directly release histamine and other chemicals from mast cells.

Doctor looking at image from coronary angiography
BSIP / UIG / Getty Images

Types of Radiocontrast Media

The two major types of contrast used are iodinated contrast (used in most CT scans) and gadolinium-based contrast (used in most MRI scans that use contrast dye). The two types are quite different and are not thought to cross-react.

Within the iodinated contrast type, there are two major subtypes:

  • Ionic high-osmolality contrast media (HOCM)
  • Non-ionic low-osmolality contrast media (LOCM)

LOCM has become the preferred form of IV dye in recent years, given its better safety record. However, it's more expensive than HOCM.

Types of Reactions

These are reactions that may occur when you've been administered RCM:

  • Mild reactions: These are relatively common, occurring in 3 to 15% of people receiving them. Most of these reactions are mild and include a feeling of warmth, nausea, and vomiting. Generally, these symptoms occur only for a short period of time and don't require treatment.
  • Moderate reactions: These include severe vomiting, hives, and swelling, and occur in an estimated 0.02 to 2% of people receiving RCM. They frequently require treatment.
  • Severe, life-threatening reactions: This includes anaphylaxis, and these occur in 0.04 to 0.02% of people receiving RCM, with a death rate of one person in every 170,000.

The likelihood of a reaction to LOCM is much lower than that with HOCM, and the likelihood of a reaction to a gadolinium-based contrast (as used in MRIs) is even lower.

Risk Factors

These factors appear to put people at higher risk for reactions to RCM:

  • Past reactions to RCM
  • Asthma
  • History of allergies
  • History of heart disease
  • History of kidney disease
  • Taking beta-blockers
  • Being elderly (at increased risk for severe reactions)

The Seafood Myth

Despite the popular myth, having a seafood and shellfish allergy does not place you at an increased risk of having a reaction to RCM. Shellfish allergy is due to the protein content of these foods, not the iodine content. In addition, if you have an allergy to topical iodine cleaners or iodides, you're at no increased risk for reactions to RCM.

Diagnosis

Unfortunately, there is no test available to diagnose an allergy to RCM. Skin testing and radioallergosorbent testing (RAST) have not been shown to be helpful in the diagnosis. Small test doses are often not helpful, with reports of severe, life-threatening reactions occurring after small amounts of RCM given, as well as severe reactions with larger doses of RCM occurring after a person tolerates a small dose of IV dye.

An IV-dye allergy can only be diagnosed after symptoms have occurred. Otherwise, it's only possible to determine that a person is at increased risk of a reaction.

Treatment

The treatment of an acute reaction to RCM is similar to that of an adverse reaction from any cause. Treatment may include injectable epinephrine and antihistamines, as well as the use of intravenous fluids for low blood pressure and shock.

It is common in patients with a history of non-severe pseudo-allergic reactions to RCM to be treated with a combination of oral corticosteroids, such as prednisone, and antihistamines, such as diphenhydramine (Benadryl) before any future contrast administrations. Patients with a history of severe reactions should avoid radio contrast media except in specific, severe circumstances under the direction of a physician.

A Word From Verywell

If you're concerned about a potential reaction to RCM, talk to your doctor about the risks and benefits of performing a test with RCM and whether alternatives are available. Your physician may be able to gain similar information by performing an MRI scan (which uses gadolinium-based contrast) rather than a CT scan. If a CT scan is required, ask whether LOCM rather than HOCM could be used.

In patients with a history of severe reactions, radio contrast should be completely avoided except in specific extreme circumstances under physician supervision.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Baerlocher MO, Asch M, Myers A. The use of contrast media. CMAJ. 2010;182(7):697. doi:10.1503/cmaj.090118

  2. Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. Biomed Res Int. 2014;2014:741018. doi:10.1155/2014/741018

  3. Pasternak JJ, Williamson EE. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist. Mayo Clin Proc. 2012;87(4):390-402. doi:10.1016/j.mayocp.2012.01.012

  4. Baig M, Farag A, Sajid J, Potluri R, Irwin RB, Khalid HM. Shellfish allergy and relation to iodinated contrast media: United Kingdom survey. World J Cardiol. 2014;6(3):107-11. doi:doi:10.4330/wjc.v6.i3.107

Additional Reading