Radiocontrast Media Hypersensitivity: Skin Testing Differentiates Allergy From Nonallergic Reactions and Identifies a Safe Alternative as Proven by Intravenous Provocation

Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivity

“…Iodine allergy is an exceptional cause of NIHR and can be excluded by patch test . Prophetic allergy testing in those without previous reaction (eg, “iodine allergy,” atopy) is not recommended .…”

Adverse reactions during procedures

“…Nearly all (96%) of severe reactions occur within 20 minutes. 8 Most commonly seen symptoms of IHRs to GBCM are urticaria (50%-90%) and nausea. 4 Anaphylaxis is rare, and the mortality rate is estimated by the Food and Drug Administration (FDA) at 8 in 100,000 doses GBCM administered.…”

“…In those cases, skin testing has been recommended. 8,42 Immediate-type hypersensitivity reactions to diagnostic dyes typically occur in a surgery setting. Thus, in most patients, various potential other elicitors of anaphylactic reactions, including latex, chlorhexidine, antibiotics, analgesics, and the dye, have been administered and should be included in the allergological workup.…”

“…36 When the culprit is positive, further skin testing with a panel of alternative contrast agents should be performed for selecting a skin testenegative alternative contrast agent for subsequent procedures, which is more likely to be tolerated. 8 The panel should be adjusted to agents available in the institution performing the future procedures.…”

“…Laboratory tests are used experimentally to understand the pathomechanism of IHRs and NIHRs and appear to be less sensitive than skin tests, but they may be helpful in confirming the diagnosis in individual patients. 8 Basophil activation test measures basophil activation, for example, by CD63 expression on basophiles via flow cytometry. 56 For patent blue, ICM and GBCM positive BAT could be shown.…”