Radiocontrast Media Hypersensitivity: Skin Testing Differentiates Allergy From Nonallergic Reactions and Identifies a Safe Alternative as Proven by Intravenous Provocation.
Adult
Aged
Aged, 80 and over
Anaphylaxis
/ chemically induced
Contrast Media
/ adverse effects
Drug Eruptions
/ diagnosis
Drug Hypersensitivity
/ diagnosis
Drug Hypersensitivity Syndrome
/ diagnosis
Female
Humans
Intradermal Tests
Iohexol
/ adverse effects
Iopamidol
/ adverse effects
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Skin Tests
Triiodobenzoic Acids
/ adverse effects
Young Adult
Anaphylaxis
Drug adverse reaction
Drug allergy
Drug hypersensitivity
Exanthem
Provocation testing
Radiocontrast media
Journal
The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220
Informations de publication
Date de publication:
Historique:
received:
11
11
2018
revised:
10
03
2019
accepted:
01
04
2019
pubmed:
14
4
2019
medline:
15
9
2020
entrez:
14
4
2019
Statut:
ppublish
Résumé
Hypersensitivity reactions occurring within minutes after intravascular injection of iodinated radiocontrast media (RCM) are not rare and have been previously considered to be nonallergic. However, in the last decades, evidence is increasing that genuine RCM allergy may present as either full-blown anaphylaxis or delayed exanthematous skin reaction. We aimed to assess whether allergy diagnostics including skin and provocation testing can differentiate between nonallergic and allergic RCM hypersensitivity by identifying the causative RCM as well as tolerated alternative RCM. We retrospectively evaluated clinical and diagnostic data from 45 consecutive patients with RCM hypersensitivity. Immediate nonallergic RCM hypersensitivity was diagnosed in 21 patients, immediate-type RCM allergy in 11, delayed-type RCM allergy in 11, and delayed-type iodine allergy in 2. All patients with immediate-type RCM allergy had a history of moderate to severe anaphylaxis. Eleven of 13 patients with delayed-type allergic reactions including the 2 cases of iodine allergy suffered from maculopapular exanthem developing several hours to days after exposure, 1 was a systemic hypersensitivity syndrome, and 1 a fixed drug eruption. Of 18 RCM-allergic patients tested, all tolerated an alternative RCM in the intravenous provocation. The diagnostic sensitivity of intradermal RCM testing to identify allergic patients is high in both immediate-type and delayed-type RCM allergy. Intravenous provocation with a skin test-negative RCM is safe and enables identification of a tolerated alternative RCM. Additional skin testing of iodine solution is required to identify patients with iodine allergy.
Sections du résumé
BACKGROUND
Hypersensitivity reactions occurring within minutes after intravascular injection of iodinated radiocontrast media (RCM) are not rare and have been previously considered to be nonallergic. However, in the last decades, evidence is increasing that genuine RCM allergy may present as either full-blown anaphylaxis or delayed exanthematous skin reaction.
OBJECTIVES
We aimed to assess whether allergy diagnostics including skin and provocation testing can differentiate between nonallergic and allergic RCM hypersensitivity by identifying the causative RCM as well as tolerated alternative RCM.
METHODS
We retrospectively evaluated clinical and diagnostic data from 45 consecutive patients with RCM hypersensitivity.
RESULTS
Immediate nonallergic RCM hypersensitivity was diagnosed in 21 patients, immediate-type RCM allergy in 11, delayed-type RCM allergy in 11, and delayed-type iodine allergy in 2. All patients with immediate-type RCM allergy had a history of moderate to severe anaphylaxis. Eleven of 13 patients with delayed-type allergic reactions including the 2 cases of iodine allergy suffered from maculopapular exanthem developing several hours to days after exposure, 1 was a systemic hypersensitivity syndrome, and 1 a fixed drug eruption. Of 18 RCM-allergic patients tested, all tolerated an alternative RCM in the intravenous provocation.
CONCLUSIONS
The diagnostic sensitivity of intradermal RCM testing to identify allergic patients is high in both immediate-type and delayed-type RCM allergy. Intravenous provocation with a skin test-negative RCM is safe and enables identification of a tolerated alternative RCM. Additional skin testing of iodine solution is required to identify patients with iodine allergy.
Identifiants
pubmed: 30980898
pii: S2213-2198(19)30376-9
doi: 10.1016/j.jaip.2019.04.005
pii:
doi:
Substances chimiques
Contrast Media
0
Triiodobenzoic Acids
0
iomeprol
17E17JBP8L
iobitridol
182ECH14UH
Iohexol
4419T9MX03
iopromide
712BAC33MZ
iodixanol
HW8W27HTXX
Iopamidol
JR13W81H44
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2218-2224Informations de copyright
Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.