Acute generalized exanthematous pustulosis (AGEP) and acute localized exanthematous pustulosis (ALEP) are rare T-cell-mediated hypersensitivity reactions most commonly triggered by medications but increasingly recognized after exposure to iodinated contrast media (ICM). With the growing use of contrast-enhanced imaging, clinicians are more frequently faced with diagnostic and management challenges in patients with suspected ICM-induced reactions and with decisions regarding future contrast exposure. This systematic review aimed to synthesize published cases of ICM-associated AGEP and ALEP, with a particular focus on clinical recognition, diagnostic evaluation in routine practice, acute management, and implications for future imaging. The review was registered in PROSPERO (CRD420251140990). Searches of PubMed/MEDLINE, Web of Science, and the Serbian Citation Index (SCIndeks) were conducted without language or date restrictions through September 9, 2025, supplemented by backward and forward citation searching. Thirty-one publications reporting 53 patients were included. Patient age ranged from 4 to 93 years (median 56 years), and most were female (64.1%). AGEP accounted for 96.2% of cases, while ALEP was rare (3.8%). AGEP was associated with iomeprol, iodixanol, iohexol, iopromide, ioversol, iopamidol, and iobitridol. ALEP was linked to iomeprol and ioversol. Onset was typically rapid, with a median of 1 day after ICM exposure. Recurrent reactions occurred in 18.9% of patients, often with shorter latency upon re-exposure. Reported management most frequently involved topical corticosteroids, systemic corticosteroids, and antihistamines. Nearly all patients (98.1%) recovered. Clinicians should recognize ICM as potential triggers of AGEP and ALEP and pursue appropriate diagnostic evaluation and allergological assessment to guide safe future imaging.
Tardioli et al. (Sun,) studied this question.