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Finding the Optimal Alternative for Immediate Hypersensitivity to Low-Osmolar Iodinated Contrast
Kyoung-Hee Sohn, Jang-Ho Seo, Dong-Yoon Kang1
1Drug Safety Center, Seoul National University Hospital, Seoul, South Korea.
Investigative Radiology
|February 15, 2021
Summary
For patients with severe hypersensitivity reactions (HSRs) to low-osmolar contrast media (LOCM), using LOCM that are negative on skin tests and lack a common side chain can ensure safe reexposure and reduce recurrence.
Area of Science:
- Radiology
- Clinical Immunology
- Pharmacology
Background:
- Hypersensitivity reactions (HSRs) to low-osmolar contrast media (LOCM) necessitate careful management for reexposure.
- Guidelines for selecting safe alternative LOCM after HSR are lacking.
Purpose of the Study:
- To investigate the safety and efficacy of reexposure to LOCM in patients with a history of immediate HSRs.
- To identify predictors of recurrent HSRs and guide the selection of alternative LOCM.
Main Methods:
- A cohort of patients with previous LOCM-associated HSRs underwent reexposure.
- Skin testing was performed to assess reactivity to various LOCM.
- The presence of a common N-(2,3-dihydroxypropyl) carbamoyl side chain was evaluated for cross-reactivity.
Main Results:
- Skin test positivity varied across mild (38.7%), moderate (45.8%), and severe (64.0%) index HSRs.
- Reexposure to skin test-negative LOCM significantly reduced recurrent HSRs from 43.8% to 12.3% (P = 0.004).
- In severe HSRs, avoiding LOCM with a common side chain reduced recurrence from 24.0% to 7.8% (P = 0.039).
Conclusions:
- For patients with severe HSRs to LOCM, reexposure to LOCM negative on skin testing and lacking a common side chain is a safe option.
- Skin test results and the presence of a common side chain are crucial for predicting cross-reactivity and ensuring safe reexposure in severe HSR cases.
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