Evaluation of basophil activation test in the management of immediate hypersensitivity reactions to gadolinium-based contrast agents: a five-year experience

Kolenda, Camille; Dubost, R. Ferrenq; Hacard, F.; Mullet, C.; Quang, Diane Le; Garnier, L.; Bienvenu, Jacques; Piriou, Vincent; Bérard, Frédéric; Bienvenu, F.; Viel, Sébastien

doi:10.1016/j.jaip.2017.01.020

Cited by 16 publications

(25 citation statements)

References 9 publications

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“…However, these techniques also have drawbacks. Some patients may be ineligible for these examinations because of contraindications to contrast agents, such as the risk of triggering or worsening renal failure with the iodinated contrast agents used for computed tomography (CT) and gadolinium diethylene-trianmine pentaacetic acid (Gd-DTPA) used for magnetic resonance imaging (MRI)[ 9 ], as well as the risk of hypersensitivity reactions caused by the agents used in CEUS, CECT, and CEMRI[ 10 ]. Additionally, these techniques are expensive and time-consuming, limiting their widespread use.…”

Section: Introductionmentioning

confidence: 99%

Application of superb microvascular imaging in focal liver lesions

Jiang

et al. 2017

WJG

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AIMTo explore the ability of superb microvascular imaging (SMI) in differential diagnosis of focal liver lesions (FLLs) and to compare SMI morphology findings to those of color Doppler ultrasound and enhanced imaging.METHODSTwenty-four patients with 31 FLLs were included in our study, with diagnoses of hemangioma (HE) (n = 17), hepatocellular carcinoma (HCC) (n = 5), metastatic lesions (n = 5), primary hepatic lymphoma (n = 1), focal nodular hyperplasia (FNH) (n = 2), and adenoma (n = 1). Nine lesions were pathologically diagnosed, and 22 lesions were radiologically confirmed, all of which were evaluated by at least two types of enhanced imaging techniques. All patients had undergone SMI. Patients were divided into subgroups based on pathological and radiological diagnoses to analyze SMI manifestations. We also compared the SMI manifestations of the most common malignant FLLs (HCCs and metastatic lesions) with those of the most common benign FLLs (HEs).RESULTSHEs were classified into three SMI subgroups: diffuse dot-like type (n = 6), strip rim type (n = 8), and nodular rim type (n = 3). The sizes of the three types of HEs were significantly different (P = 0.00, < 0.05). HCCs were classified into two subgroups: diffuse honeycomb type (n = 2) and non-specific type (n = 3). Four of the metastatic lesions were the strip rim type, and the other metastatic lesion was the thick rim type, which is the same as that of lymphoma. FNH was described as a spoke-wheel type, and adenoma as a diffuse honeycomb type. The SMI types of HCCs and metastatic lesions were significantly different from those of HEs (P = 0.048, < 0.05).CONCLUSIONSMI technology enables microvascular evaluation of FLLs without using any contrast agent. For HEs, lesion size may affect SMI performance. SMI is able to provide useful information for differential diagnosis of HCCs and metastatic lesions from HEs.

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Section: Introductionmentioning

confidence: 99%

Application of superb microvascular imaging in focal liver lesions

Jiang

et al. 2017

WJG

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“…In patients with histories of severe reactions (see Appendix A) to unknown CM, in both elective and urgent examinations, we advise that radiological investigations be performed in a safe environment and in the presence of the anesthesiologist, due to the undemonstrated effectiveness of premedication [29,[31][32][33] and the risk of cross-reactivity among CM of the same class, both iodine-based [13,17,[37][38][39][40][41][42][43][44][45][46][47][48] and gadolinium-based [49].…”

Section: The Role Of the Anesthesiologistmentioning

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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“…56 For patent blue, ICM and GBCM positive BAT could be shown. [57][58][59] For ICM, BAT has been regularly used, but mostly in small sample sizes, and good data on sensitivity are still lacking, whereas specifity is estimated at 88.4% to 100%. Basophil activation test with ICM was suggested to be useful for confirmation of IHR to ICM.…”

Section: Laboratory Testsmentioning

confidence: 99%

“…60 Sensitivity of BAT in GBCM has been estimated at 93%, however, based on a small number of patients. 59 Leukocyte histamine release testing was also described in IHRs to ICM, as well as lymphocyte transformation testing in NIHRs. 40…”

Section: Laboratory Testsmentioning

confidence: 99%

“…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%

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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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Evaluation of basophil activation test in the management of immediate hypersensitivity reactions to gadolinium-based contrast agents: a five-year experience

Cited by 16 publications

References 9 publications

Application of superb microvascular imaging in focal liver lesions

Application of superb microvascular imaging in focal liver lesions

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

Adverse reactions during procedures

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