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Hypersensitivity Reactions to Multiple Iodinated Contrast Media.

Inmaculada Doña1, Gádor Bogas1, María Salas1

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Hypersensitivity reactions to iodinated contrast media (ICM) are increasingly common. Allergy to multiple ICMs is frequent, often confirmed by skin tests and drug provocation tests, necessitating careful diagnostic work-ups.

Keywords:
anaphylaxisdrug allergydrug provocation testexanthemahypersensitivityiodinated contrast mediaskin testurticaria

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Area of Science:

  • Allergy and Immunology
  • Radiology
  • Pharmacology

Background:

  • Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) are a growing clinical concern.
  • Diagnosis of ICM-HSRs is challenging due to variable skin test (ST) sensitivity and heterogeneous drug provocation test (DPT) protocols.

Purpose of the Study:

  • To describe clinical characteristics and diagnostic procedures for HSRs to ICM.
  • To investigate cases of confirmed allergy to multiple ICMs.

Main Methods:

  • Prospective evaluation of 101 patients with suspected ICM-HSRs, classified as immediate (IRs) or non-immediate (NIRs).
  • Skin tests (STs) performed with a panel of ICMs.
  • Single-blind placebo-controlled DPT conducted for negative ST results.
  • Tolerance assessed with alternative ICMs if ST or DPT were positive.

Main Results:

  • 35.64% of confirmed allergic patients (101 total) reacted to multiple ICMs (36/101).
  • Patients allergic to multiple ICMs showed a higher percentage of positive STs (IRs: 62.5%; NIRs: 85.71%) compared to single ICM allergy.
  • Drug provocation tests (DPTs) with alternative ICMs were positive in over 60% of multi-ICM allergic cases.

Conclusions:

  • Allergy to multiple ICMs is common and associated with severe reactions, particularly immediate reactions.
  • Positive skin tests frequently confirm multi-ICM allergy.
  • Allergological work-up should include DPT to diagnose and identify safe alternatives, even with negative STs or structurally unrelated ICMs.