Debunking Iodine Allergy Misconceptions: 4 Vital Myths Every Nurse Should Know

“Iodine Allergy” flagged on a patient’s chart requires a series of changes that can significantly alter a patient’s course of care. This can range from switching the skin antisepsis solution to avoiding diagnostic imaging that uses iodinated contrast agents. These changes can lead to delays, cancellations, and poor outcomes.

So, what is an iodine allergy, and how should it impact periop care?

This question led Laila S. Bailey, DNP, RN, CNOR, ACNS-BC, Urology, Cystoscopy, and Pediatric Surgery service leader at Inova Fairfax Hospital in Falls Church, VA, on an unexpected research journey. Dr. Bailey, an adjunct nursing professor and recognized expert in perioperative nursing research and practice, has more than 35 years of experience as a perioperative nurse.

Her skills were put to the test in 2021 when an iodinated contrast solution shortage prompted Dr. Bailey to investigate iodine alternatives. Her research delved into three key areas: iodinated contrast reactions, the relationship between the properties of different contrast agents, and the risk of contrast reactions.

As her research progressed, she realized that perioperative views on iodine-containing substances needed reevaluation. For example, “patients who have had any allergy to anything containing iodine, usually shellfish, are labelled with an iodine allergy—but this label is false.”

Iodine Myths and Facts Every Nurse Must Understand

Dr. Bailey is sharing her findings widely. And that includes presenting at AORN Global Surgical Conference & Expo in April in Nashville, and in an upcoming article in the AORN Journal.

She gave us a quick rundown of the myths versus facts surrounding patient iodine allergies to help periop nurses debunk common misunderstandings:

Myth#1

If a patient is allergic to any iodine-containing substance, they are allergic to all of them.

Fact: This is false. There is no relationship between allergies to different iodine-containing products. Each iodine-containing substance used in perioperative care must be evaluated individually.

Myth #2:

A person allergic to shellfish is automatically allergic to povidone-iodine and iodinated contrast media.

Fact: Again, this is false. These reactions are not related in any way. Shellfish allergy is caused by a protein in the shellfish, usually tropomyosin. Povidone-iodine for skin antisepsis and iodinated contrast solution are safe to use in patients with a shellfish allergy.

Myth #3:

Iodine products used in perioperative care contain iodine that triggers allergic reactions.

Fact: Iodine is an element and is essential for protein synthesis and thyroid hormone development. Iodine cannot stimulate the immune system and cannot be an allergen. When patients react to iodine-containing products, it is not the iodine, but other parts of the substances that cause reactions. For example, skin irritation from povidone-iodine, is caused by a separate chemical in the solution, such as the povidone or a dye. When contrast is injected, the osmolarity (thickness) of the fluid can cause mast cells to release histamine, leading to a hypersensitivity reaction (not an allergic reaction).

Myth #4:

The belief that iodine allergy practice changes do not affect patient care and outcomes.

Fact: Patients labeled as iodine allergic experience delays in care and poorer outcomes. For example, iodine-alternative skin prep solutions may not be as effective, increasing a patient’s risk for surgical site infection.

Learn More

Dr. Bailey shared a few publications that have helped her investigation:

• Iodine allergy: myth or reality?
• The Relationship of Radiocontrast, Iodine, and Seafood Allergies: A Medical Myth Exposed
• Debunking Myths About “Allergy” to Radiocontrast Media in an Academic Institution

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