Risk factors associated with immediate hypersensitivity reaction to contrast media: a systematic review and meta-analysis

Objective To determine the risk factors associated with immediate hypersensitivity reactions to contrast media (CM-IHR). Materials and methods A systematic search was conducted in PubMed, Embase, Ovid, Web of Science database and the Cochrane Library up to December 2024 to identify studies in which risk factors associated with CM-IHR were explored. The Newcastle-Ottawa Scale was used to assess the risk of bias. Odds ratios (ORs) with 95% confidence intervals (CIs) for each risk factor were pooled from the selected studies. Heterogeneity was evaluated via the Higgins I 2 test. Results From 8,342 citations, seven were ultimately included in the meta-analysis, encompassing a total of 115,043 patients and 736,203 injections. The methodological quality was rated as high in six studies and moderate in one. Four studies investigated iodinated CM (ICM), while 3 investigated gadolinium-based contrast agent. Female sex (OR 1.46; 95 % CI 1.33–1.59) was identified as a significant risk factor for CM-IHR, and age showed an inverse association with risk (OR 0.98; 95 % CI 0.98–0.99). Asthma history was not suggested as a significant risk factor (OR 1.12; 95 % CI, 0.95–1.33; I 2 = 0 %). For ICM-IHR specifically, outpatient status was associated with higher risk (OR, 3.08; 95 % CI, 1.13–8.44). Notably, pooled analysis of two studies suggested a trend toward increased risk with prior history of hypersensitivity reaction to ICM; however, this association was not statistically significant and was accompanied by high heterogeneity (OR 7.49; 95 % CI, 0.42–135.09, I 2 = 87 %). Conclusions Our systematic review and meta-analysis suggest that female sex was a significant risk factor for CM-IHR, whereas increasing age was associated with a lower risk. Outpatient status showed a significant association with ICM-IHR. Prior history of hypersensitivity reaction to ICM was not identified as a significant risk factor. Given the small number of available studies and substantial heterogeneity, these findings should be interpreted with caution.