The Potential Utility of Iodinated Contrast Media (ICM) Skin Testing in Patients with ICM Hypersensitivity

Abstract

Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.Graphical Abstract

Immediate Hypersensitivity Reactions Induced by Triamcinolone in a Patient with Atopic Dermatitis

“…The SPT was done to evaluate type I IgE-mediated allergy by confirming allergen-specific IgE. 5 It was done on the volar aspect of the forearm, using commercially available topical steroids. 5 7 A 1-mm single-peak lancet with shoulder was used.…”

“…We observe time-course results every 15 minutes. 1 5 All steroids showed negative open test results after 30 minutes ( Fig. 2 ).…”

Evaluating Factors Affecting Clinicians’ Knowledge on Contrast Media: Kenyan Experience

“…In addition to initiating a lifesaving intervention, clinicians that recognize anaphylactic reactions from contrast media may be more likely to diagnose hypersensitivity syndromes. This can play a role in counseling about necessary precautions since similar pathways can be found in cases of other anaphylaxes (12,13). The mean scores from this study indicate a lack of knowledge regarding contrast agents as well as adverse reaction risk among clinicians in Kenya.…”

Successful desensitization to radiocontrast media in two high-risk cardiac patients

“…There is high cross-reactivity between different types of RCM agents in patients presenting with anaphylaxis, and a positive skin test. 7 In a recent meta-analysis, 8 cross reactivity between iohexol and iodixanol was reported as 10% (5–23%) based on results of skin test-positive patients, but data is scarce regarding cross-reactivity between iohexol and iodixanol in patients with negative skin testing. Therefore, it is difficult to determine the role of performing desensitization with iodixanol instead of the initial culprit agent, iohexol.…”