Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivity

Abstract

Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivityRadiocontrast media (RCM) are concentrated solutions of tri-iodinated benzene derivatives for enhancement of radiographic contrast.Adverse reactions associated with RCM administration can either be hypersensitivity reactions, toxic reactions (eg, generalized pruritus, heat sensation, flushing, nausea) or events unrelated to RCM exposure (eg, spontaneous urticaria). 1 Hypersensitivity reactions are clas-None.

Hypersensitivity Reactions to Multiple Iodinated Contrast Media

“…Patients were classified as IRs or NIRs if reactions appeared within 1 h after ICM administration or after (Demoly et al, 2014). The clinical categories included urticaria, angioedema, and anaphylaxis for IRs, and maculopapular exanthema and delayed urticaria for NIRs (Brockow et al, 2019;Brockow, 2020). Patients with severe cutaneous reactions as Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized pustulosis, or drug reaction with eosinophilia and systemic symptoms were excluded from the study.…”

“…Over the last decade, the incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen in parallel with their increased usage (Brockow et al, 2005;Brockow, 2020), being estimated to occur in about 0.5-2% of patients receiving ICMs (Brockow et al, 2005). HSRs to ICMs are classified into immediate (IRs) and non-immediate reactions (NIRs) according to if they occur within one hour or within hours or even days, respectively, after administration (Brockow et al, 2005;Brockow, 2020). Reactions may vary from mild to severe, being skin the organ most frequently involved (Brockow et al, 2005;Torres et al, 2012;Salas et al, 2013;Brockow, 2020).…”

“…HSRs to ICMs are classified into immediate (IRs) and non-immediate reactions (NIRs) according to if they occur within one hour or within hours or even days, respectively, after administration (Brockow et al, 2005;Brockow, 2020). Reactions may vary from mild to severe, being skin the organ most frequently involved (Brockow et al, 2005;Torres et al, 2012;Salas et al, 2013;Brockow, 2020). HSRs to ICMs have traditionally been considered as non-allergic, but growing evidence points to immune mechanisms.…”

“…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). However, its use is controversial as it is a not-risk free procedure (Aberer et al, 2003) and doses administered during the allergological work-up lack of consensus, varying from 10 to 120 cc and being injected on a single day or incrementally increased over several days (Vernassiere et al, 2004;Torres et al, 2012;Prieto-Garcia et al, 2013;Salas et al, 2013;Sese et al, 2016;Lerondeau et al, 2016;Morales-Cabeza et al, 2017;Gracia-Bara et al, 2019;Soria et al, 2019;Trautmann et al, 2019).…”

“…The management of patients diagnosed as having HSRs to ICMs involves prohibiting the use of the culprit ICM and identifying non-cross-reactive agents that can be safely used by the patient (Brockow, 2020). Currently, controversies exist regarding the pattern of cross-reactivity.…”