Allergological workup with half‐dose challenge in iodinated contrast media hypersensitivity

Soria, Angèle; Masson, Nathalie; Vial-Dupuy, A.; Gaouar, H.; Amsler, E.; Chollet‐Martin, Sylvie; Nicaise-Roland, Pascale; Autegarden, Jean‐Eric; Barbaud, A.

doi:10.1111/all.13638

Cited by 13 publications

(23 citation statements)

References 9 publications

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“…This increased incidence is a concern for doctors and patients as HSR diagnosis implies avoiding ICMs, which are required for radiological examination or treatment of different entities. The evaluation of HSRs to ICMs has been gaining attention over recent years (Brockow et al, 2005;Brockow et al, 2009;Hasdenteufel et al, 2011;Torres et al, 2012;Salas et al, 2013;Lerondeau et al, 2016;Sese et al, 2016;Soria et al, 2019;Trautmann et al, 2019;Brockow, 2020). The allergological work-up not only confirms or excludes the diagnosis but also finds safe alternative ICM.…”

Section: Discussionmentioning

confidence: 99%

“…It is based on the clinical history, STs, and DPTs, although their role has not been fully established. The diagnostic sensitivity of STs has been reported to range from less than 5% to more than 90% (Vernassiere et al, 2004;Kvedariene et al, 2006;Trcka et al, 2008;Brockow et al, 2009;Dewachter et al, 2011;Goksel et al, 2011;Torres et al, 2012;Prieto-Garcia et al, 2013;Morales-Cabeza et al, 2017), being its routine use still matter of debate (Brockow et al, 2009;Caimmi et al, 2010;Goksel et al, 2011;Prieto-Garcia et al, 2013;Yoon et al, 2015;Soria et al, 2019). DPT is considered the gold standard for diagnosing HSRs to drugs (Aberer et al, 2003), and, in the case of HSRs to ICMs, it is recommended to be performed with the ICM giving negative results in STs for confirming diagnosis or looking for a safe alternative (Rosado Ingelmo et al, 2016;Brockow, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…DPT is considered the gold standard for diagnosing HSRs to drugs (Aberer et al, 2003), and, in the case of HSRs to ICMs, it is recommended to be performed with the ICM giving negative results in STs for confirming diagnosis or looking for a safe alternative (Rosado Ingelmo et al, 2016;Brockow, 2020). However, its use is controversial as it is a not-risk free procedure (Aberer et al, 2003) and doses administered during the allergological work-up lack of consensus, varying from 10 to 120 cc and being injected on a single day or incrementally increased over several days (Vernassiere et al, 2004;Torres et al, 2012;Prieto-Garcia et al, 2013;Salas et al, 2013;Sese et al, 2016;Lerondeau et al, 2016;Morales-Cabeza et al, 2017;Gracia-Bara et al, 2019;Soria et al, 2019;Trautmann et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Hypersensitivity Reactions to Multiple Iodinated Contrast Media

et al. 2020

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The incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer after ICM administration. The diagnosis of HSRs to ICM is complex as skin test (ST) sensitivity ranges widely, and drug provocation test (DPT) protocols are heterogeneous. In this manuscript, we describe the clinical characteristics of a series of patients confirmed as HSR to ICM and the diagnosis procedure carried out, looking into those cases confirmed as HSRs to multiple ICMs. For this purpose, we prospectively evaluated patients suggestive of HSRs to ICMs and classified them as IRs or NIRs. STs were carried out using a wide panel of ICMs, and in those with a negative ST, a single-blind placebo controlled DPT was performed with the culprit. If ST or DPT were positive, then tolerance was assessed with an alternative negative ST ICM. We included 101 cases (12 IRs and 89 NIRs) confirmed as allergic. Among them, 36 (35.64%) cases were allergic to more than one ICM (8 IRs and 28 NIRs). The most common ICM involved were iomeprol and iodixanol. Although not statistically significant, the percentage of patients reporting anaphylaxis was higher in patients allergic to multiple ICMs compared with patients allergic to a single ICM (50 vs. 25%). Likewise, the percentage of positive results in STs was higher in patients allergic to multiple ICMs compared with those allergic to a single ICM (for IR 62.5 vs. 25%, p > 0.05; and for NIR, 85.71 vs. 24.59%, p < 0.000). In cases allergic to more than one ICM, DPT with negative-ST ICM was positive in more than 60% (24/36) of cases. Therefore, allergy to multiple ICMs is common, associated to severe reactions in IRs, and confirmed frequently by positive STs. The allergological workup should include DPT not only to establish the diagnosis but also to identify safe alternative ICM, even if ICM is structurally unrelated and ST is negative. More studies are needed to clarify mechanisms underlying cross-reactivity among ICMs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypersensitivity Reactions to Multiple Iodinated Contrast Media

et al. 2020

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“…Intravenous drug provocation test (DPT) with a skin testenegative contrast agent (ICM or GBCM) has been increasingly described, but it is neither part of routine allergological workup yet nor standardized and validated. 39,59,[61][62][63][64] For fluorescein, conjunctival DPT has been reported as additional diagnostical step when all skin tests were negative. 65 Severe reactions to DPT have been reported, and DPT could cause side effects such as kidney damage when using ICM or nephrogenic systemic fibromatosis when using GBCM.…”

Section: Drug Provocation Testmentioning

confidence: 99%

“…65 Severe reactions to DPT have been reported, and DPT could cause side effects such as kidney damage when using ICM or nephrogenic systemic fibromatosis when using GBCM. 61 Because of its risk of hypersensitivity reactions, DPT should be performed in experienced and well-equipped institutions. Performing DPT may be considered especially in patients after severe anaphylaxis with a skin testenegative alternative contrast medium, because DPT has a higher sensitivity than skin testing alone.…”

Section: Drug Provocation Testmentioning

confidence: 99%

Adverse reactions during procedures

Schönmann

Brockow

2020

Annals of Allergy, Asthma & Immunology

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Incidences of hypersensitivity reactions to contrast media and dyes are low, but because of their frequent use, the absolute number of hypersensitivity reactions is relevant and represents a clinical problem in allergology. Hypersensitivity reactions can be divided into 2 groups: immediate hypersensitivity (urticaria/angioedema/anaphylaxis) and nonimmediate hypersensitivity reactions (exanthems). Allergological workup (skin tests AE laboratory tests) is helpful to confirm an allergic mechanism and in those in whom the culprit is positive also to select skin test-negative alternatives for future procedures. For patients needing urgent re-administration without the possibility of allergological workup, the decision on avoidance of contrast media or readministration of one other than the culprit agent with premedication and emergency preparedness is based on the severity of the initial reaction. Provocation tests in an allergy department under emergency preparedness may be considered to confirm tolerance to an alternative contrast medium for readministration.

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