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In imaging, most are mild or moderate, while severe reactions are very rare. A standardized risk assessment and close patient monitoring are crucial. In addition to liberal use of supportive treatment by oxygen and volume expansion, the main drugs for treatment of individual reactions include intramuscular adrenaline and H1-antihistamines, with limited indications for short-acting \u03b22-agonists (SABA) like salbutamol or albuterol. As these reactions occur infrequently, these situations often create stress and confusion. During treatment, the stability or progression of the reaction should be constantly assessed, assigning a specific task to each team member. In addition, detailed documentation and correct classification of the severity of such reactions will help improve the risk management in future imaging studies. Regular hands-on training for all personnel involved in managing these reactions is mandatory. To help, the ESUR Contrast Media Safety Committee has reviewed the literature on hypersensitivity reactions and updated its guidance on how to appropriately manage, treat, and document immediate and non-immediate hypersensitivity reactions to contrast media in adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Hypersensitivity reactions to contrast media may require immediate action to prevent further damage to the patient. Guidance on management would help improving preparedness.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Clear treatment protocols with cards or flowcharts are mandatory. Intramuscular adrenaline is the most important drug for treatment. Documentation should be agent-specific and standardized.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The ESUR Contrast Media Safety Committee has updated its guidance on how to appropriately manage, treat, and document immediate and non-immediate hypersensitivity reactions to contrast media in adults.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11675-1","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T12:27:20Z","timestamp":1748348840000},"page":"6798-6810","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Hypersensitivity reactions to contrast media: Part 1. Management of immediate and non-immediate hypersensitivity reactions in adults. Updated guidelines by the ESUR Contrast Media Safety Committee"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2376-9424","authenticated-orcid":false,"given":"Aart J.","family":"van der Molen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annick A. J. M.","family":"van de Ven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Vega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona A.","family":"Dekkers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remy W. 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O.C.: Bracco Imaging, Guerbet, Bayer Healthcare. J.M.C.: Bracco Imaging, Guerbet. C.C.Q.: Bracco Imaging, Guerbet, Bayer Healthcare, GE Healthcare. A.R.: Bracco Imaging, Guerbet, Bayer Healthcare, GE Healthcare. M.F.B. is a member of the Advisory Editorial Board for\n                      European Radiology\n                      (European Society of Urogenital Radiology). T.B. is a member of the Scientific Editorial Board for\n                      European Radiology\n                      (Section Editor: Contrast Media). As such, they did not participate in the selection or review processes for this article. 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