Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study

Tepetam, Fatma Merve; Çiftaslan, Nezihe; Oruç, Özlem; Duman, Dildar; Ağca, Meltem; Bulut, İsmet; Çolakoğlu, Bahattin

doi:10.1007/s11547-016-0646-1

Cited by 10 publications

(3 citation statements)

References 29 publications

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“…One study reported on patients that had hypersensitivity reactions to ICM or gadolinium-based contrast media. 39 Of the 10 patients with an IHR and three with a NIHR, none showed a positive skin test. Of those, one patient with a previous NIHR response to ICM, tolerated the gadolinium-based contrast medium.…”

Section: Resultsmentioning

confidence: 92%

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

Bansie

Karim

Maaren

et al. 2021

Int J Immunopathol Pharmacol

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Introduction: Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. Methods: A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. Results: Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. Conclusion: In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

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Section: Resultsmentioning

confidence: 92%

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

Bansie

Karim

Maaren

et al. 2021

Int J Immunopathol Pharmacol

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“…Prior to an imaging study with CM, a thorough medical history must be taken by the prescribing physician and/ or the radiologist to identify at-risk patients. Table 2 shows the risk stratification of patients in 3 groups: group 2 (high-risk patients), with histories of hypersensitivity reactions (mild, moderate, or severe) to CM of the same chemical class of the one to be administered (i.e., GBCM or ICM) [1,7,17,18,20]; group 1 (low-risk patients), with concomitant diseases, such as uncontrolled asthma [21,22], active urticaria-angioedema [2,22], mastocytosis [19]; and group 0 (subjects at risk very low), for example those with histories of allergic reactions to causative agents other than CM, such as foods [23], drugs [24], and iodine-containing antiseptics (e.g., iodopovidone or iodoform) [25].…”

Section: Risk Stratification Of Patientsmentioning

confidence: 99%

“…There is no standardized premedication regimen, with differences between the North American and European recommendations. Specifically, premedication is not recommended by ESUR guidelines on CM [18] because "there is not [19] Atopy [19] Intravascular CM injection [23] Severe cardiovascular disease [23] Viral infection and autoimmune diseases [1] Psychiatric disorders [23] Interleukin-2 treatment and contact allergy (for NIHRs) [2] Treatment with ACE-inhibitors, beta-blockers, or proton pump inhibitors (for IHRS) [19] Food allergy [23] Drug allergy [24] Concomitant allergic disease [23] Allergy to iodine-containing antiseptics [ good evidence of its effectiveness". Instead, premedication with glucocorticoids, antihistamines, and sympathomimetics to prevent severe reactions to CM is the standard of care in all US institutions [26,34].…”

Section: Premedicationmentioning

confidence: 99%

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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Gadolinium-induced anaphylaxis with positive skin test results

Rodriguez‐Nava

Kesler

Carrillo-Martín

et al. 2019

Annals of Allergy, Asthma & Immunology

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Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study

Cited by 10 publications

References 29 publications

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

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

Gadolinium-induced anaphylaxis with positive skin test results

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