The Evidence for and Against Corticosteroid Prophylaxis in At-Risk Patients.

Corticosteroid prophylaxis is commonly used for the prevention of allergiclike reactions to iodinated and gadolinium-based contrast material in patients at highest risk of an allergiclike reaction. However, it has only a weak mitigating effect on allergiclike reactions, probably does not affect the severity of subsequent reactions, and does not prevent all reactions. Breakthrough reactions occur, are usually the same severity as the index reaction, and can occasionally be life threatening. Premedication of inpatients is likely associated with substantial cost and harm because of hospital length-of-stay prolongation; these indirect effects may exceed the benefits of premedication in this population.