Anaphylaxis to Iodinated Contrast Material: Nonallergic Hypersensitivity or IgE-Mediated Allergy?

Trcka, Jiri; Schmidt, Claudia; Seitz, Cornelia S.; Bröcker, Eva‐B.; Gross, Gerd; Trautmann, Axel

doi:10.2214/ajr.07.2872

Cited by 154 publications

(132 citation statements)

References 33 publications

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“…Nonallergic reactions are not suggestive of allergic reactions [77]. They usually occur within the first hour after administration, but can happen after longer intervals and be confused with accelerated reactions; however, these reactions are usually milder.…”

Section: Nonallergic Reactionsmentioning

confidence: 99%

“…The sensitivity of skin tests for immediate reactions varies from 4.2% to 73% [15,16,77,82]. Such high variability may be due to the different concentrations used in the studies (undiluted ICM can be associated with false positives), the time between the reaction and the study, the clinical symptoms of the patients included, symptom severity, and the type of ICM (ionic or nonionic) [81].…”

Section: Skin Testsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Rosado¹,

Díaz²,

Moreno³

et al. 2016

J Investig Allergol Clin Immunol

122

124

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The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported. Key words: Iodinated. Gadolinium. Contrast media. Allergy. Hypersensitivity. Anaphylaxis. Immediate reactions. Nonimmediate reactions. PrologueThe objective of these guidelines is to ensure efficient and effective clinical practice in the diagnosis and management of hypersensitivity reactions to radiologic contrast media. The guidelines were developed by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) with extensive clinical expertise in the evaluation and management of hypersensitivity reactions and broad research experience.We performed a systematic and independent review of the literature up to November 2015 and established a consensus of expert opinion. We evaluated the applicability of the guidelines in our daily clinical practice. The guidelines were evaluated and criticized by external reviewers with expertise in the field. MethodThe panel of experts who produced this consensus document developed a research protocol outlining the background to the subject of study, the objectives of the study, and the questions and hypotheses from which search criteria were defined.The main sources used for the literature search included electronic databases and archives (MEDLINE-PubMed, Science Direct, OVID) and a database of systematic re...

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Section: Nonallergic Reactionsmentioning

confidence: 99%

Section: Skin Testsmentioning

confidence: 99%

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Rosado¹,

Díaz²,

Moreno³

et al. 2016

J Investig Allergol Clin Immunol

122

124

View full text Add to dashboard Cite

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“…Important examples of such drugs are X-ray contrast media (in general, iodinated contrast media, most frequently iomeprol and iopromide) (46), muscle relaxants (most frequently suxamethonium) (47), certain antibiotics like DNA gyrase inhibitors, and some opioids (48, 49). Another mechanism of triggering anaphylaxis may be supporting allergen persistence.…”

Section: Other Drugs Relevant To Anaphylaxismentioning

confidence: 99%

About the role and underlying mechanisms of cofactors in anaphylaxis

Wölbing

Fischer

Köberle

et al. 2013

Allergy

175

163

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Anaphylaxis is the systemic and most severe presentation of type I allergy. A number of conditions were identified that modulate the onset of anaphylaxis such as co-or augmentation factors, which significantly lower the allergen dose necessary for triggering anaphylaxis. Next to physical exercise or alcohol consumption, co-administration of nonsteroidal anti-inflammatory drugs (NSAID) or concomitant infectious diseases are well-documented cofactors of anaphylaxis. Registries for anaphylaxis document a role for cofactors in about 30% of anaphylactic reactions. Some disease entities such as 'wheat-dependent exercise-induced anaphylaxis' (WDEIA) are explicitly characterized by elicitation of anaphylaxis only in the presence of at least one such cofactor. Using WDEIA as a model disease, studies demonstrated that exercise increases skin prick test reactivity to and bioavailability of the allergen. Additional data indicate that alcohol consumption and NSAID administration display similar effects. Modulation of the cellular activation threshold is another mechanism underlying cofactor-induced anaphylaxis, most likely also functional when infectious diseases orchestrate elicitation of anaphylaxis. Cofactors are increasingly accepted to play a fundamental role in eliciting anaphylaxis. Consequently, to improve patient management modalities, a better understanding of the underlying mechanisms is warranted. This review aims to update clinicians and clinical scientists on recent developments.

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“…true allergy) being a much less frequent secondary mechanism. A skin testing study showed that only 4% of patients with anaphylaxis symptoms had an IgE-mediated mechanism [16]. Delayed reactions from 1 hour to 7 days after injection of CM are T-cell mediated and most typically are skin reactions.…”

Section: Contrast Allergiesmentioning

confidence: 99%

“…[18] Patients with a history of severe CM allergy who will likely need IV CM injection should probably receive pre-exposure prophylaxis with corticosteroids as well as H1 antagonists although strong evidence of benefit is lacking. [16] The likely mechanism for the benefit of corticosteroids is a reduction in circulating basophils and eosinophils available for direct activation. If CM administration cannot be delayed for 4-6 hours after steroid injection, some would omit use and administer only H1 blockers.…”

Section: Contrast Allergiesmentioning

confidence: 99%