Radiocontrast media (RCM) are common elicitors of immediate and nonimmediate hypersensitivity reactions, manifesting predominantly as urticaria/anaphylaxis or exanthems, respectively. In the minority of patients with immediate hypersensitivity reactions to RCM allergy is demonstrated by positive skin tests. However, data show that assessment by an allergist/immunologist is beneficial for managing patients with previous immediate and nonimmediate hypersensitivity reactions. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test–negative preparations should be applied. The efficacy of this strategy is confirmed by drug provocation tests or exposures confirming or excluding RCM hypersensitivity and demonstrating tolerability of alternative RCM.