Practice Parameters for Diagnosing and Managing Iodinated Contrast Media Hypersensitivity

Torres, Marı́a José; Trautmann, Axel; Böhm, Ingrid; Hofmeier, Kathrin Scherer; Barbaud, A.; Bavbek, Sevim; Bonadonna, Patrizia; Cernadas, Josefina; Chiriac, Anca Mirela; Gaeta, Francesco; Giménez‐Arnau, Ana M.; Kang, Hye-Ryun; Moreno, Esther; Brockow, Knut

doi:10.22541/au.159542454.46698241

Cited by 3 publications

(8 citation statements)

References 84 publications

(225 reference statements)

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“…Secondly, the other limitation was our time interval between the reaction and allergological evaluation. It is recommended that skin tests be performed ideally within the first 6 months after a clinical reaction (8). In our study, this median period was determined to be 10 months, and it may have caused a decrease in skin test reactivity due to IgE clearance.…”

Section: Discussionmentioning

confidence: 98%

“…However, controversies continue over the diagnostic approach, prediction, and premedication. The latest guidelines suggest that skin tests should be performed first with a panel of RCM including the culprit agent (3,8). However, the most common problem encountered in daily clinical practice is that patients do not know the contrast agent used in their previous reaction or have difficulty in accessing this information.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of premedication is known but also contradictory. There are several studies on RCM hypersensitivity reporting the efficacy of premedication for skin test negative patients and also for the patients whose culprit agent is unknown (8,14). On the other hand, there are studies that indicate breakthrough reactions may develop despite premedication (15).…”

Section: Discussionmentioning

confidence: 99%

“…Iohexol was administered if the previous agent was unknown and the skin test with iohexol was negative. In cases with severe reactions, the contrast agent was generally not recommended again according to a comprehensive risk-benefit analysis (8). As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed (9).…”

Section: Methodsmentioning

confidence: 99%

“…Immediate hypersensitivity reaction medication may be our classification of reactions up to 1 hour as immediate and after 1 hour as non-immediate in accordance with Brockow's recommendations, while this limit was accepted as 6 hours in the latest position paper of the European Academy of Allergy and Clinical Immunology (EAACI)(2,8…”

mentioning

confidence: 99%

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The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

Bostan¹,

Çakmak²,

Kaya³

et al. 2021

Asthma Allergy Immunol

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Objective: Controversies continue over the diagnostic approach, prediction, and premedication in radiocontrast media (RCM) hypersensitivity. One of the most important problems encountered in daily clinical practice is that patients do not recall which contrast agent has been used in previous exposures. Also, in most cases, the details of the reaction have not been recorded. Therefore, difficulties are experienced in decision-making about skin testing and premedication in patients who are suspected of RCM hypersensitivity. To assess the clinical value of skin tests and premedication in RCM hypersensitivity. Materials and Methods: A retrospective evaluation was made of the medical records of patients between October 2014 and December 2019. The skin tests were performed with the culprit agent if it was known, otherwise, with iohexol, one of the most commonly used RCM in Turkey. As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed. Results: A total of 41 patients were evaluated (32 females and 9 males). Of the reactions, 35 (85.4%) were immediate and 6 (14.6%) were non-immediate. Three (7.3%) had a positive intradermal test result. It was determined that 20 patients (17 immediate, 3 non- immediate), required imaging with RCM again. Of these, 18 received premedication and two did not, although it was recommended. Of the patients who received premedication, one (5.5%) had an urticarial reaction of the same grade, while both patients (100%) who did not receive premedication developed an immediate allergic reaction that was of a similar grade to that of the previous reaction. Conclusion: Skin test positivity for RCM was observed at low rates. In cases with negative skin tests and when the culprit drug cannot be identified, re-exposure to alternative RCM under premedication may reduce the risk of the reaction. Keywords: Allergy, iodinated contrast media, iobitridol, iohexol, premedication

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

Bostan¹,

Çakmak²,

Kaya³

et al. 2021

Asthma Allergy Immunol

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Challenges in the diagnostic approach of suspected pulmonary embolism in COVID-19 patients

Stals

Kaptein

Kroft

et al. 2021

Postgraduate Medicine

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Accumulating studies on COVID-19 patients report high incidences of thrombotic complications, but guidance on the best diagnostic approach for suspected pulmonary embolism (PE) in COVID-19 patients is lacking. Diagnosing PE in these patients is challenging as signs and symptoms of PE and COVID-19 show wide overlap, D-dimer levels are often elevated in the absence of thrombosis and computed tomography pulmonary angiography (CTPA) may be unfeasible in the case of severe renal impairment and/or hemodynamic instability.This narrative review discusses available literature and guidelines on current diagnostic algorithms for suspected PE in special patient populations, in particular COVID-19. A special focus is on reviewing the literature aimed at identifying symptoms with a high suspicion for PE and on the diagnostic performance of diagnostic algorithms for suspected PE in the setting of COVID-19.Based on available literature, the index of suspicion for PE should be high in the case of unexplained abrupt worsening of respiratory status, typical symptoms of deep-vein thrombosis and/or acute unexplained right ventricular dysfunction. Despite the lack of prospective diagnostic management studies, we propose to adhere to current diagnostic algorithms applying assessment of pretest probability and D-dimer testing as available evidence suggests that these might be considered safe. Preferably, algorithms using adjusted D-dimer thresholds are recommended as it likely improves the yield of the clinical decision rule/D-dimer combination.

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Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivity

Brockow

2020

Allergy

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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.

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Practice Parameters for Diagnosing and Managing Iodinated Contrast Media Hypersensitivity

Cited by 3 publications

References 84 publications

The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

Challenges in the diagnostic approach of suspected pulmonary embolism in COVID-19 patients

Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivity

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