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Immediate reactions to iodinated contrast media
Cristina Morales-Cabeza1, Dasha Roa-Medellín1, Inés Torrado1
1Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Summary
Immediate hypersensitivity reactions (IHRs) to iodinated contrast media (ICMs) can be managed using skin tests and controlled challenge tests (CCTs). These tests help identify specific IgE-mediated mechanisms and find alternative, non-cross-reactive ICMs for patients.
Area of Science:
- Allergy and Immunology
- Radiology
- Pharmacology
Background:
- Immediate hypersensitivity reactions (IHRs) to iodinated contrast media (ICMs) are a significant clinical issue.
- Positive skin tests and basophil activation tests suggest an IgE-mediated mechanism in some IHRs.
- Skin testing and controlled challenge testing (CCT) are valuable tools for managing patients with IHRs to ICMs.
Purpose of the Study:
- To investigate the clinical and allergologic characteristics of IHRs to ICMs.
- To evaluate the utility of skin tests and CCTs in identifying specific triggers and cross-reactivity.
- To compare the global reaction rates of different ICMs.
Main Methods:
- Retrospective analysis of 342 reactions in 329 patients over 7 years.
- Allergy workup including skin tests for 196 patients.
- CCTs performed with alternative ICMs for patients with positive skin test results.
Main Results:
- Cutaneous symptoms were the most frequent manifestation (87.7%).
- Positive skin tests were observed in 7.6% of evaluated patients, with more severe reactions in this group.
- Low-grade cross-reactivity was noted, particularly between iopamidol and ioversol. Iomeprol showed a higher reaction rate compared to iopamidol and ioversol.
Conclusions:
- Positive skin tests can indicate an IgE-mediated mechanism in a subset of patients with IHRs to ICMs.
- Skin test-guided CCT is effective in identifying alternative, non-cross-reactive ICMs.
- Further research is needed to elucidate the mechanisms underlying IHRs in patients with negative skin test results.
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