Immediate reactions to iodinated contrast media

Morales‐Cabeza, Cristina; Roa-Medellin, Dasha; Torrado, Inés; Barrio, M. De; Fernández-Álvarez, Carmen; Montes-Aceñero, Juan Francisco; Riva, Inmaculada De La; Prieto-García, Alicia

doi:10.1016/j.anai.2017.08.014

Cited by 39 publications

(62 citation statements)

References 16 publications

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“…The increased incidence of HSR with repeated exposure may be the result of IgE-mediated sensitization. Growing evidence demonstrates that IgE-mediated allergic reactions may be at least partly involved in immediate hypersensitivity to LOCM [17,40]. However, it is still unclear whether immediate HSR to LOCM is IgE-dependent or IgE-independent (eg, direct mast cell activation or complement activation).…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

Lee¹,

Kang²,

Kim³

et al. 2019

J Investig Allergol Clin Immunol

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Objectives: We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM. Methods: This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM 2 oS). Results: The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not. Conclusion: The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM.

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Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

Lee¹,

Kang²,

Kim³

et al. 2019

J Investig Allergol Clin Immunol

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“…It is based on the clinical history, STs, and DPTs, although their role has not been fully established. The diagnostic sensitivity of STs has been reported to range from less than 5% to more than 90% (Vernassiere et al, 2004;Kvedariene et al, 2006;Trcka et al, 2008;Brockow et al, 2009;Dewachter et al, 2011;Goksel et al, 2011;Torres et al, 2012;Prieto-Garcia et al, 2013;Morales-Cabeza et al, 2017), being its routine use still matter of debate (Brockow et al, 2009;Caimmi et al, 2010;Goksel et al, 2011;Prieto-Garcia et al, 2013;Yoon et al, 2015;Soria et al, 2019). DPT is considered the gold standard for diagnosing HSRs to drugs (Aberer et al, 2003), and, in the case of HSRs to ICMs, it is recommended to be performed with the ICM giving negative results in STs for confirming diagnosis or looking for a safe alternative (Rosado Ingelmo et al, 2016;Brockow, 2020).…”

Section: Introductionmentioning

confidence: 99%

Hypersensitivity Reactions to Multiple Iodinated Contrast Media

et al. 2020

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The incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer after ICM administration. The diagnosis of HSRs to ICM is complex as skin test (ST) sensitivity ranges widely, and drug provocation test (DPT) protocols are heterogeneous. In this manuscript, we describe the clinical characteristics of a series of patients confirmed as HSR to ICM and the diagnosis procedure carried out, looking into those cases confirmed as HSRs to multiple ICMs. For this purpose, we prospectively evaluated patients suggestive of HSRs to ICMs and classified them as IRs or NIRs. STs were carried out using a wide panel of ICMs, and in those with a negative ST, a single-blind placebo controlled DPT was performed with the culprit. If ST or DPT were positive, then tolerance was assessed with an alternative negative ST ICM. We included 101 cases (12 IRs and 89 NIRs) confirmed as allergic. Among them, 36 (35.64%) cases were allergic to more than one ICM (8 IRs and 28 NIRs). The most common ICM involved were iomeprol and iodixanol. Although not statistically significant, the percentage of patients reporting anaphylaxis was higher in patients allergic to multiple ICMs compared with patients allergic to a single ICM (50 vs. 25%). Likewise, the percentage of positive results in STs was higher in patients allergic to multiple ICMs compared with those allergic to a single ICM (for IR 62.5 vs. 25%, p > 0.05; and for NIR, 85.71 vs. 24.59%, p < 0.000). In cases allergic to more than one ICM, DPT with negative-ST ICM was positive in more than 60% (24/36) of cases. Therefore, allergy to multiple ICMs is common, associated to severe reactions in IRs, and confirmed frequently by positive STs. The allergological workup should include DPT not only to establish the diagnosis but also to identify safe alternative ICM, even if ICM is structurally unrelated and ST is negative. More studies are needed to clarify mechanisms underlying cross-reactivity among ICMs.

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“…The ICM dose for intravenous provocation tests (IPTs) during allergological workup lacks consensus. Nine studies reported various modalities and doses for ICM challenge (10-120 mL), with negative predictive value (NPV) of skin tests vs challenge ranging from 37.5% to 100% [1][2][3][4][5][6][7]10 ( Table 1). A cross-reactivity classification of ICM in three subgroups was proposed by Lerondeau et al 8 The objective of this prospective study was to determine the NPV for skin tests as compared with IPT 50 mL, which is half the usual dose for radiologic explorations.…”

Section: Allergological Workup With Half-dose Challenge In Iodinated mentioning

confidence: 99%

Allergological workup with half‐dose challenge in iodinated contrast media hypersensitivity

Soria

Masson

Vial-Dupuy

et al. 2018

Allergy

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Immediate reactions to iodinated contrast media

Cited by 39 publications

References 16 publications

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

Hypersensitivity Reactions to Multiple Iodinated Contrast Media

Allergological workup with half‐dose challenge in iodinated contrast media hypersensitivity

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