Skin Test-Guided Strategy to Select Alternative Iodinated Contrast Media in Patients With Immediate Hypersensitivity...

Area of Science:

• Allergy and Immunology
• Radiology
• Pharmacology

Background:

• Iodinated contrast media (ICM) frequently cause immediate hypersensitivity reactions (IHR).
• Repeated administration of ICM is often clinically necessary, necessitating strategies to prevent recurrent hypersensitivity.
• Standardized protocols are required for managing patients with a history of IHR to ICM.

Purpose of the Study:

• To propose and evaluate an intradermal skin test (IDT)-guided strategy for preventing IHR recurrence in patients previously exposed to ICM.
• To identify safe alternative ICM agents for patients with positive skin tests to the culprit ICM.

Main Methods:

• A prospective multicenter study involved patients with a history of IHR to ICM.
• Intradermal skin testing (IDT) with the causative ICM was performed. Alternative ICM were selected based on IDT results.
• Patients underwent subsequent computed tomography examinations with premedication, and recurrence/severity of hypersensitivity was assessed.

Main Results:

• Of 496 enrolled participants, 299 were reexposed to ICM.
• The IDT-guided protocol was followed by 269 participants, with 84.8% experiencing no adverse reactions.
• In contrast, 53.3% of participants who did not follow the protocol experienced recurrent IHR (P < .001).
• The protocol also significantly reduced the severity of IHR in cases where reactions did occur (P = 0.003).

Conclusions:

• An IDT-guided strategy is effective in reducing the recurrence of IHR to ICM.
• This approach also mitigates the severity of hypersensitivity reactions in patients who do experience recurrence.
• The study supports the recommendation of IDT for diagnosing ICM allergy and identifying safe alternatives.