001042 - Searching for an Alternative Contrast Agent in a Patient with Allergy to Multiple Macrocyclic Gadolinium-Based Contrast Agents

Gadolinium-based contrast agents (GBCA) can lead to gadolinium deposition in thebrain and nephrogenic systemic fibrosis, particularly linear GBCAs. For this reason,recent guidelines recommend avoiding the use of linear agents, prioritizing theadministration of macrocyclic GBCA.

We report a 61-year-old woman who experienced dyspnea and generalized urticariaimmediately after undergoing magnetic resonance imaging with gadoteridol, amacrocyclic GBCA. The episode resolved after intravenous administration ofmethylprednisolone and dexchlorpheniramine.

Skin tests with macrocyclic GBCA (gadobutrol and gadoterate meglumine) wereperformed. Prick tests (1:1 concentration) were negative for both agents. Intradermaltesting (1:10 dilution) was negative for gadoterate meglumine but positive forgadobutrol.An intravenous provocation test with gadoterate meglumine was subsequentlyconducted using a rapid administration protocol (0.2 mL/kg in bolus) withoutpremedication, which resulted in immediate urticaria.Given that the patient was sensitized to all three available macrocyclic GBCA, anallergy study was extended to gadobenate dimeglumine, a linear GBCA. Skin tests forgadobenate dimeglumine were negative, and an intravenous rapid provocation test (0.2mL/kg in bolus) without premedication was performed, demonstrating good tolerance.

We present a case of a patient sensitized to three macrocyclic GBCA (gadobutrol,gadoteridol, and gadoterate meglumine) who showed good tolerance to a linear GBCA(gadobenate dimeglumine).The presence of a negative skin test for a GBCA does not guarantee tolerance. Then, itis necessary to confirm safety through a provocation test using the same methodology assubsequent clinical administration (full dose in bolus and without premedication).