Impact of discontinuing routine corticosteroid premedication on contrast reaction rates in high-risk patients: A clinical audit

Zena Arumugam; Nithiya Jayamani; Han Bin Ong; Wei Liang Hong; Wei Ping Tham; Lai Peng Chan; Nguyen Tuan Anh Tran

doi:10.46475/asean-jr.v27i3.1002

Authors

Zena Arumugam, M.M.I.S. Department of Radiography, Singapore General Hospital, Outram Road, 169608, Singapore.
Nithiya Jayamani, M.Sc. Department of Radiography, Singapore General Hospital, Outram Road, 169608, Singapore.
Ong Han Bin, M.M.I.S. Department of Radiography, Singapore General Hospital, Outram Road, 169608, Singapore.
Hong Wei Liang, M.Sc. Department of Radiography, Singapore General Hospital, Outram Road, 169608, Singapore.
Tham Wei Ping, M.Med., F.R.C.R. Department of Radiology, Singapore General Hospital, Outram Road, 169608, Singapore.
Chan Lai Peng, M.B.B.S., F.R.C.R. Department of Radiology, Singapore General Hospital, Outram Road, 169608, Singapore.
Tran Nguyen Tuan Anh, M.D., F.R.C.R. Department of Radiology, Singapore General Hospital, Outram Road, 169608, Singapore.

DOI:

https://doi.org/10.46475/asean-jr.v27i3.1002

Keywords:

Allergies, Contrast media, Contrast reactions, Corticosteroid premedication, High-risk patients

Abstract

Background: Recent guidelines question the efficacy of routine corticosteroid premedication for patients with asthma or multiple drug allergies undergoing contrast-enhanced computed tomography (CECT), citing limited evidence of its effectiveness.

Objective: To evaluate the incidence of documented contrast reactions following the cessation of routine corticosteroid premedication in high-risk patients.

Materials and Methods: A retrospective single-centre audit was conducted from September 2021 to April 2022, including 527 patients undergoing CECT. Routine corticosteroid premedication was discontinued for high-risk patients (those with known asthma or multiple drug allergies, defined as allergies to three or more drug classes), except for individuals with confirmed contrast media allergies. Demographic and clinical data, including reaction severity, were collected using REDCap. Reaction rates between premedicated and non-premedicated groups were compared using appropriate statistical tests for categorical and continuous variables.

Results: Of 527 patients, 82 received premedication and 445 did not. Reaction rates were 1.2% (1/82) in the premedicated group and 0.4% (2/445) in the non-premedicated group (p = 0.4). All observed reactions were mild (grade 1–2), consisting mainly of urticaria, with no severe reactions recorded in either group. Demographics were comparable between groups.

Conclusion: Discontinuing routine corticosteroid premedication for high-risk patients was not associated with a statistically significant increase in contrast reactions in this audit and aligns with current guideline recommendations from professional bodies. However, due to the small number of events and the retrospective design, these findings should be interpreted with caution. Further studies are needed to confirm the safety of this approach in broader patient populations.

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