Asthma Severity Is a Risk Factor for Acute Hypersensitivity Reactions to Contrast Agents

Kobayashi, Daiki; Takahashi, Osamu; Ueda, Toshihisa; Arioka, Hiroko; Akaishi, Yu; Fukui, Tsuguya

doi:10.1378/chest.11-3143

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…factors [6,[23][24][25][26][27]. The main risk factor seems to be a previous reaction, even if a significant number of subjects experienced HS to ICM on the first exposure [4;22].…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Isn't it time to consider oncological status as a new risk factor of iodinated contrastdia hypersensitivity?

Dellis

Pirson

2022

Eur Ann Allergy Clin Immunol

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Background:The literature describes several risk factors for hypersensitivity (HS) reactions to iodinated contrast media (ICM). Objective:To analyze the characteristics of patients experiencing HS reactions to ICM with a focus on oncological status.Methods: All patients (n=80) with suspected HS to ICM who underwent an allergy evaluation in a Belgian University Hospital over a 5-year period were retrospectively included.Results: Overall, forty patients (50%) had a history of neoplasia, and this group was characterized by less atopy (p<0.004). No significant difference was observed between oncological and non-oncological patients in terms of gender, age, cardiovascular diseases, medical treatment, and number of previous exposures or reactions to ICM. Conclusion:A high proportion of oncological patients was observed in our population with HS to ICM. They did not have other known risk factors, and they were less atopic. Larger multicentric studies should explore cancer as a potential new risk factor.

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“…factors [6,[23][24][25][26][27]. The main risk factor seems to be a previous reaction, even if a significant number of subjects experienced HS to ICM on the first exposure [4;22].…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Isn't it time to consider oncological status as a new risk factor of iodinated contrastdia hypersensitivity?

Dellis

Pirson

2022

Eur Ann Allergy Clin Immunol

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“…Table I lists some of the most frequently described risk factors [37][38][39][40]. Additional risk factors for immediate reactions that are common to allergic drug reactions include poorly controlled bronchial asthma, concomitant medications (eg, ACE inhibitors, ß-blockers, and proton pump inhibitors), rapid administration of the drug, mastocytosis, autoimmune diseases, and viral infections [10,11,38,[41][42][43][44][45][46].…”

Section: Epidemiologymentioning

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

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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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“…Prior to an imaging study with CM, a thorough medical history must be taken by the prescribing physician and/ or the radiologist to identify at-risk patients. Table 2 shows the risk stratification of patients in 3 groups: group 2 (high-risk patients), with histories of hypersensitivity reactions (mild, moderate, or severe) to CM of the same chemical class of the one to be administered (i.e., GBCM or ICM) [1,7,17,18,20]; group 1 (low-risk patients), with concomitant diseases, such as uncontrolled asthma [21,22], active urticaria-angioedema [2,22], mastocytosis [19]; and group 0 (subjects at risk very low), for example those with histories of allergic reactions to causative agents other than CM, such as foods [23], drugs [24], and iodine-containing antiseptics (e.g., iodopovidone or iodoform) [25].…”

Section: Risk Stratification Of Patientsmentioning

confidence: 99%

SIRM-SIAAIC consensus, an Italian document on management of patients at risk of hypersensitivity reactions to contrast media

Costantino¹,

Romanini

Gaeta

et al. 2020

Clin Mol Allergy

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Hypersensitivity reactions (HRs) to contrast media (CM) can be distinguished in immune-mediated (including allergic reactions) and non-immune-mediated reactions, even if clinical manifestations could be similar. Such manifestations range from mild skin eruptions to severe anaphylaxis, making it important for radiologists to know how to identify and manage them. A panel of experts from the Società Italiana di Radiologia Medica e Interventistica (SIRM) and the Società Italiana di Allergologia, Asma e Immunologia Clinica (SIAAIC) provided a consensus document on the management of patients who must undergo radiological investigations with CM. Consensus topics included: the risk stratification of patients, the identification of the culprit CM and of a safe alternative by an allergy workup, as well as the use of premedication and the correct procedure to safely perform an elective (i.e., scheduled) or urgent examination. The most important recommendations are: (1) in all patients, a thorough medical history must be taken by the prescribing physician and/or the radiologist to identify at-risk patients; (2) in patients with hypersensitivity reactions to CM, the radiologist must consider an alternative, non-contrast imaging study with a comparable diagnostic value, or prescribe a different investigation with another class of CM; (3) if such options are not feasible, the radiologist must address at-risk patients to a reference centre for an allergy evaluation; (4) if timely referral to an allergist is not viable, it is recommended to use a CM other than the responsible one, taking into account cross-reactivity patterns; in the case of patients with histories of severe reactions, the presence of an anesthesiologist is also recommended and a premedication is suggested.

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Asthma Severity Is a Risk Factor for Acute Hypersensitivity Reactions to Contrast Agents

Cited by 10 publications

References 4 publications

Isn't it time to consider oncological status as a new risk factor of iodinated contrastdia hypersensitivity?

Isn't it time to consider oncological status as a new risk factor of iodinated contrastdia hypersensitivity?

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

SIRM-SIAAIC consensus, an Italian document on management of patients at risk of hypersensitivity reactions to contrast media

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