Allergy and contrast media

Dewachter, Pascale; Mouton‐Faivre, C.; Felden, F.

doi:10.1034/j.1398-9995.2001.056003250.x

Cited by 56 publications

(44 citation statements)

References 4 publications

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“…Serum levels of histamine may be elevated in some, but not all individuals after an acute severe anaphylactoid reaction. 13 Tryptase levels have also been found to be elevated in this setting; blood analysis may be obtained at the time of symptom onset and several days after resolution for comparison. 14 Skin testing by skin prick, intradermal, and patch methods can be used to identify patients at risk for reactions, particularly those who have reported a prior anaphylactoid reaction and are expected to require a repeat exposure to contrast.…”

Section: Manifestations and Incidencementioning

confidence: 98%

Nonrenal Complications of Contrast Media

Marycz¹,

Ziada²

2014

Interventional Cardiology Clinics

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Nonrenal complications of contrast media are caused by chemotoxic or anaphylactoid reactions related to the contrast agent used. Chemotoxicity is mainly attributed to ionic concentration and osmolality. Anaphylactoid reactions are typically caused by direct activation of basophils, mast cells, and complement rather than an observable antigen-antibody interaction, and may be acute or delayed. History of an adverse reaction following prior exposure is the strongest predictor of a subsequent adverse reaction to contrast. Premedication regimens of corticosteroids or antihistamines can lower the risk of repeat adverse reactions. Treatment of anaphylactoid reactions depends on the severity of symptoms.

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Section: Manifestations and Incidencementioning

confidence: 98%

Nonrenal Complications of Contrast Media

Marycz¹,

Ziada²

2014

Interventional Cardiology Clinics

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“…Elevated serum levels of histamine and tryptase have been found in some but not all patients with severe or fatal immediate reactions, but not in those with milder symptoms [3]. The peak concentration was observed 15–30 min after the reaction and the elimination half-time in plasma was 90 min to 2 h [15].…”

Section: Discussionmentioning

confidence: 99%

“…Immediate hypersensitivity reactions are unusual but when happening are potentially life-threatening and may request urgent management. Iodinated CM are responsible for the vast majority of such reactions, with a frequency of 0.1–0.4% for ionic and 0.02–0.04% for nonionic agents [1,2,3,4]. …”

Section: Introductionmentioning

confidence: 99%

Anaphylaxis to Gadobenate Dimeglumine (Multihance®): A Case Report

Kalogeromitros

Makris

Aggelides

et al. 2007

Int Arch Allergy Immunol

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Background: Gadolinium chelates are relatively safe contrast media used in MRI. Immediate severe adverse effects are exceptionally rare and mostly concern mild anaphylactoid reactions. We report a case of anaphylaxis to gadobenate dimeglumine (Gd-BOPTA, Multihance®), a gadolinium-based contrast agent. Methods: A 32-year-old female patient with a personal history of multiple sclerosis, while undergoing an MRI scan, developed bronchospasm and acute urticaria with diffuse giant pruritic plaques in the first minute of Gd-BOPTA infusion. The procedure was cancelled and acute treatment of the reaction took place. The patient reported 2 additional MRI scans with definite use of unknown contrast media in the past 2 years without any adverse effect. Blood samples were obtained 2 and 48 h after the reaction for measurement of serum tryptase concentration (Pharmacia Diagnostics, Uppsala, Sweden). Skin prick tests and intradermal tests were performed using 1:1,000, 1:100 and 1:10 dilution of the offending agent and alternative gadolinium-based agents [gadodiamide (Omniscan®) and gadoteric acid (Dotarem®)]. A group of 10 nonatopic individuals who underwent the same skin testing comprised the control group. Results: Tryptase concentration was highly elevated 2 h after the reaction (21 µg/l) compared with that at 48 h (3 µg/l). Skin prick tests in our patient were all negative, while intradermal testing with 0.03 ml of 1:100 and 1:10 preparations of Multihance showed a definite positive wheal-and-flare reaction. Skin tests to the alternative agents showed no response. In the control group, all performed tests were negative. Conclusion: We report the first case of an allergic reaction to gadobenate dimeglumine. Besides, skin testing seems to be a precious diagnostic tool which, if positive, strongly suggests a mast cell-mediated underlying mechanism.

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“…À partir des années 1990, des cas d'allergies IgEdépendantes au PCI injecté sont rapportés, faisant écho à ce qui avait été suggéré 50 ans auparavant. Ainsi, plus d'une centaine de cas de réactions allergiques immédiates de grade I à IVoù le diagnostic étiologique est documenté par le résul-tat des tests cutanés parfois associé à l'augmentation de la concentration de tryptase est publié (Tableau 3) [8,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Quelques décès sont rapportés.…”

Section: Produits De Contraste Iodésunclassified

“…Le cycle benzénique tri-iodé commun à l'ensemble des PCI exclut l'imputabilité de l'atome d'iode [4,22,24]. En effet, l'injection sans incident d'un PCI négatif en tests cutanés chez des patients ayant présenté une réaction allergique IgEdépendante documentée à un PCI est rapportée chez une vingtaine de patients (Tableau 3) [24][25][26]28,32,35,36]. En outre, aucune réactivité cutanée croisée n'a été identifiée entre les PCI et la povidone iodée [22,23] ou la solution de Lugol (iodure de potassium iodé) [22] ou encore l'amiodarone alors que l'atome d'iode est commun à ces médicaments.…”

Section: Produits De Contraste Iodésunclassified

Allergie immédiate aux produits de contraste iodés

Dewachter

Mouton‐Faivre

2014

Ann. Fr. Med. Urgence

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L'hypersensibilité immédiate de nature allergique ou non allergique fait partie des effets indésirables rapportés avec les produits de contraste iodés (PCI). Leurs incidences et prévalences demeurent inconnues. Le diagnostic étiolo-gique d'une réaction d'hypersensibilité immédiate après injection de PCI est fondé sur l'analyse de l'histoire clinique confrontée aux résultats de la biologie (histamine et tryptase) et à ceux des tests cutanés. La comparaison de ces éléments permet d'identifier le mécanisme physiopathologique de la réaction clinique (allergique vs non allergique), le PCI impliqué et de déterminer une conduite à tenir lors de procédures radiologiques ultérieures. La séquence épitopique des PCI n'a pas été identifiée mais ne correspond pas à l'atome d'iode. Il n'y a pas de communauté antigénique entre les produits de la mer, la povidone iodée et les PCI. Une allergie documentée aux produits de la mer ou à la povidone iodée ne contre-indique donc pas l'injection d'un PCI. L'atopie, l'asthme, les β-bloquants ne sont pas des facteurs de risque de survenue d'une allergie immédiate aux PCI. À l'inverse, un asthme non contrôlé par un traitement de fond majore le risque de décès au cours d'une anaphylaxie. Les arguments scientifiques en faveur de l'utilité d'une prémédi-cation afin d'éviter une réaction allergique immédiate aux PCI font défaut. Une conduite à tenir est proposée lorsqu'un patient étiqueté « allergique à l'iode » ou ayant présenté une réaction immédiate avec un PCI explorée ou non, et adressé au service des urgences, doit bénéficier d'une procédure avec injection de PCI.Mots clés Anaphylaxie · Agents de contraste · Hypersensibilité immédiate · Povidone iodée · Produits de la mer Abstract Allergic and non-allergic immediate hypersensitivity are reported side effects of iodinated contrast media (ICM). Their incidence and prevalence remain unknown. The etiologic diagnosis of an ICM-induced immediate reaction relies on a triad including clinical, biological and allergological evidence. Consideration of these arguments helps identify the pathophysiologic mechanism (allergic versus non-allergic), the culprit ICM and provide a clinical decision-making pathway for further procedures. The epitopes causing immediate hypersensitivity following ICM remain unknown but do not correspond to the iodine atom itself. Since there is no cross-reactive allergenic determinants between ICM, seafood, and povidone iodine, ICM can be injected in case of a documented allergy to seafood or povidone iodine. Atopy, asthma and β-blocking agents are not risk factors of ICM-induced immediate allergy. Conversely, uncontrolled asthma is a risk factor of fatal anaphylaxis. Scientific evidence in favor of preemptive therapeutic strategies to prevent IgE-mediated allergy in the radiological setting are lacking. We also provide a management plan for patients labelled as "allergic to iodine" or having experienced an investigated or uninvestigated ICM-induced immediate hypersensitivity and that need to receive ICM in the ED setting.

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Allergy and contrast media

Cited by 56 publications

References 4 publications

Nonrenal Complications of Contrast Media

Nonrenal Complications of Contrast Media

Anaphylaxis to Gadobenate Dimeglumine (Multihance®): A Case Report

Allergie immédiate aux produits de contraste iodés

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