Diagnosis of immediate hypersensitivity reactions to radiocontrast media

Gómez, Francisca; Fernandez, Tahía D.; Doña, Inmaculada; Aranda, Ana; Ariza, Adriana; Blanca‐López, Natalia; Mayorga, Cristobalina; Blanca, Miguel; Torres, Marı́a José

doi:10.1111/all.12214

Cited by 75 publications

(129 citation statements)

References 14 publications

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“…Several studies support the finding of specific IgE-mediated immunological mechanisms in immediate reactions, and positive skin test results with ICM have been reported in patients who experience severe immediate reactions [14][15][16]. Some of these patients also react to other ICM to which they had not been previously exposed, probably because the core chemical structure common to ICM is part of the antigenic determinant and thus induces cross-reactivity.…”

Section: Immediate Reactionsmentioning

confidence: 67%

“…While these observations do not constitute direct evidence of an IgE-related mechanism, but rather of mast cell activation [14,59], recent studies have also indirectly shown the presence of specific IgE using the basophil activation test [16,17,53].…”

Section: Immediate Reactionsmentioning

confidence: 87%

“…This observation gives cause for concern, because, unlike immediate reactions, nonimmediate reactions cannot be well controlled by pretreatment with corticosteroids and antihistamines (see below, Treatment). The most frequent culprits ICM for both immediate and nonimmediate reactions are iomeprol and iodixanol [16,33].…”

Section: Epidemiologymentioning

confidence: 99%

“…However, there is growing evidence that a group of these reactions can be induced by specific immunological mechanisms [14,50,51], a hypothesis that seems increasingly likely with the reporting of cases with immediate positive skin test and basophil activation test results [16].…”

Section: Immediate Reactionsmentioning

confidence: 99%

“…Immediate reactions have long been attributed to non-IgEmediated mechanisms [9], although there is growing evidence that tryptase levels increase after the reaction. Furthermore, positive skin test or basophil activation test results could support an IgE-mediated mechanism in some cases [13][14][15][16][17]. The prevalence of nonimmediate hypersensitivity reactions has increased significantly in the last decade, whereas that of immediate reactions has decreased, with the result that nonimmediate reactions are now more frequent than immediate reactions [18].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Rosado¹,

Díaz²,

Moreno³

et al. 2016

J Investig Allergol Clin Immunol

112

119

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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: Immediate Reactionsmentioning

confidence: 67%