Ep. 168 Debunking Contrast Allergies with Dr. Cullen Ruff

We talk with Dr. Cullen Ruff about common misconceptions when it comes to IV contrast and issues with the "contrast allergy", including ways we can improve patient care and clinical workflows by clarifying the true source of these reactions.

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SHOW NOTES

In this episode, diagnostic radiologist Dr. Cullen Ruff and our host Dr. Chris Beck discuss the research and patient education surrounding contrast allergies.

Dr. Cullen starts the episode by commenting on the history of contrast media, noting that the earlier ionic contrast agents are more allergenic than the more recent non-ionic ones. By knowing the time period during which many radiologists switched to non-ionic agents (around 1985), we can identify during a medical history which of these types caused a patient’s allergic reaction.

The doctors discuss current research, which shows that substituting for a different contrast media is more effective than giving steroid premedication and using the allergy-inducing contrast media. Unfortunately, many patients are unable to recall the year when they experienced their allergy or the name of the contrast agent given. This lack of information makes it difficult to administer a substitute contrast media to the patient.

To address these workflow inefficiencies, Dr. Cullen advocates for individualized patient education over specific contrast allergies. He believes that taking the time to discuss allergies and giving the patient the name of their allergen, in writing, is essential for future imaging studies. He advises against the use of the vague and nonsensical term of “iodine allergy”, noting that patients are never allergic to the iodine itself, but rather a different component in the iodinated contrast media.

Finally, we discuss Dr. Cullen’s book, “Looking Within: Understanding Ourselves Through Human Imaging” in which he shares patient stories and introduces the general public to the retrospective and predictive values of diagnostic imaging.

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RESOURCES

“Patients Have a Very Limited Knowledge of Their Contrast Allergies”:

https://www.clinicalimaging.org/article/S0899-7071(21)00324-7/fulltext

“Prevention of Allergic-like Reactions at Repeat CT: Steroid Pretreatment versus Contrast Material Substitution”:

https://pubmed.ncbi.nlm.nih.gov/34342504/

“Iodine Allergy: Common Misperceptions”:

https://academic.oup.com/ajhp/article-abstract/78/9/781/6129459

American College of Radiology Manual on Contrast Media, 2021:

https://www.acr.org/Clinical-Resources/Contrast-Manual

Dr. Cullen’s book, “Looking Within: Understanding Ourselves Through Human Imaging”:

https://www.cullenruff.com/books

“The Immunology of the Vermiform Appendix: A Review of the Literature”:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011360/