Novel Strategy for the Prevention of Recurrent Hypersensitivity Reactions to Radiocontrast Media Based on Skin Testing

Kwon, Oh Young; Lee, Ji‐Hyang; Park, Soyoung; Seo, Bomi; Won, Ha-Kyeong; Kang, Yewon; An, Jin; Kwon, Hyouk‐Soo; Song, Woo-Jung; Cho, You Sook; Moon, Hee‐Bom; Kim, Tae‐Bum

doi:10.1016/j.jaip.2019.04.036

Cited by 29 publications

(40 citation statements)

References 17 publications

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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%

“…According to them, the evaluation of patients with ICM-induced anaphylaxis or exanthema should always include appropriate skin tests ensuring that patients with IgE-mediated or delayed-type allergy are not missed [26]. Moreover, skin testing with a large panel of CM may identify alternative CM that could be tolerated in future radiologic investigations [13,[38][39][40][41][42][43][44][45][46][47][48].…”

Section: Allergy Testing Skin Testsmentioning

confidence: 99%

“…Considering that the DPT is not indicated when the offending drug is unlikely to be needed [51] and that the DPT with CM involves the risk of severe reactions, there is a general consensus in recommending that it be carried out only in selected cases using a skin-test negative CM to identify an alternative compound for future use [19,26,46]. Interestingly, in studies that performed DPTs with negatively skin-tested alternative ICM in at least 10 subjects [39,40,[44][45][46][47][48], the rate of positive responses to DPTs ranged from 0 [39,46,48] to 36.1% (13 of 36) [40].…”

Section: Drug Provocation Testmentioning

confidence: 99%

“…Cross-reactivity among ICM has been reported, especially in subjects with delayed reactions [13,17,[37][38][39][40][41][42][43][44][45][46][47][48] and seems to depend, at least in part, on the chemical structure of the CM [39,43,45]. The ICM most frequently involved in cross-reactions are iodixanol, iohexol, iopentol, ioversol, and iomeprol.…”

Section: Cross-reactivitymentioning

confidence: 99%

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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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Section: The Role Of the Anesthesiologistmentioning

confidence: 99%

Section: Allergy Testing Skin Testsmentioning

confidence: 99%

Section: Drug Provocation Testmentioning

confidence: 99%

Section: Cross-reactivitymentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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“…For ICM, sensitivity of skin testing has been shown to depend on the severity of 53 The negative predictive value (NPV) of skin testing in IHR to ICM has been reported by different authors to be 94%-98% and 68-86% for NIHR. 36,45,50,54,55 However, these studies were not done only in patients with positive skin test to the culprit, but also in those (nonallergic) patients with no positive skin test at all. No data are available on the positive predictive value of skin testing, because a re-administration of a skin testepositive drug is highly likely to cause a reaction and would thus be unethical.…”

Section: Allergy Tests Following Allergological Workupmentioning

confidence: 99%

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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Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital

Liu

Qiu

Liu

et al. 2023

Med Biol Eng Comput

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For contrast-enhanced CT examinations, there is a lack of comprehensive optimal management strategies of risk factors to reduce the risk of iodinated contrast media (ICM)–induced acute adverse reactions (AAR). Here, we determine the relationship between the rate of ICM-AAR and a stratified assessment and warning (SAW) regimen, which integrated risk identification, stratification, early warning, and prevention. A total of 120,822 cases in the conventional assessment period (58 years ± 15, 55.25% men) and 150,343 cases (58 years ± 14, 55.83% men) in the SAW period were enrolled. The results showed that the total AAR incidence in the SAW period (414/150,343, 0.28%) was lower than that in the conventional assessment period (506/120,822, 0.42%, P < 0.001), in which the proportion of AAR patients decreased by one-third. It mainly presented as decreases in mild and moderate reactions (P < 0.001), and a decrease in the proportion of moderate AAR patients (P = 0.001). Subgroup analysis showed lower mild and moderate AAR incidence in patients with different risk levels and with different ICM injection parameters following SAW regimen. We concluded that SAW regimen was associated with lower incidence of mild and moderate AAR, and decreased proportion of moderate AAR patients, which held potential for improved ICM safety. Graphical abstract

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Novel Strategy for the Prevention of Recurrent Hypersensitivity Reactions to Radiocontrast Media Based on Skin Testing

Cited by 29 publications

References 17 publications

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

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

Adverse reactions during procedures

Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital

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