Hypersensitivity Reactions to Multiple Iodinated Contrast Media
The incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer afte...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphar.2020.575437/full |
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| author | Inmaculada Doña Gádor Bogas María Salas Almudena Testera Esther Moreno Jose Julio Laguna María José Torres María José Torres María José Torres |
| author_facet | Inmaculada Doña Gádor Bogas María Salas Almudena Testera Esther Moreno Jose Julio Laguna María José Torres María José Torres María José Torres |
| author_sort | Inmaculada Doña |
| collection | DOAJ |
| description | The incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer after ICM administration. The diagnosis of HSRs to ICM is complex as skin test (ST) sensitivity ranges widely, and drug provocation test (DPT) protocols are heterogeneous. In this manuscript, we describe the clinical characteristics of a series of patients confirmed as HSR to ICM and the diagnosis procedure carried out, looking into those cases confirmed as HSRs to multiple ICMs. For this purpose, we prospectively evaluated patients suggestive of HSRs to ICMs and classified them as IRs or NIRs. STs were carried out using a wide panel of ICMs, and in those with a negative ST, a single-blind placebo controlled DPT was performed with the culprit. If ST or DPT were positive, then tolerance was assessed with an alternative negative ST ICM. We included 101 cases (12 IRs and 89 NIRs) confirmed as allergic. Among them, 36 (35.64%) cases were allergic to more than one ICM (8 IRs and 28 NIRs). The most common ICM involved were iomeprol and iodixanol. Although not statistically significant, the percentage of patients reporting anaphylaxis was higher in patients allergic to multiple ICMs compared with patients allergic to a single ICM (50 vs. 25%). Likewise, the percentage of positive results in STs was higher in patients allergic to multiple ICMs compared with those allergic to a single ICM (for IR 62.5 vs. 25%, p > 0.05; and for NIR, 85.71 vs. 24.59%, p < 0.000). In cases allergic to more than one ICM, DPT with negative-ST ICM was positive in more than 60% (24/36) of cases. Therefore, allergy to multiple ICMs is common, associated to severe reactions in IRs, and confirmed frequently by positive STs. The allergological work-up should include DPT not only to establish the diagnosis but also to identify safe alternative ICM, even if ICM is structurally unrelated and ST is negative. More studies are needed to clarify mechanisms underlying cross-reactivity among ICMs. |
| first_indexed | 2024-12-11T05:30:40Z |
| format | Article |
| id | doaj.art-96f847f2cdb64efebcf904fa32b24a64 |
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| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-11T05:30:40Z |
| publishDate | 2020-09-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-96f847f2cdb64efebcf904fa32b24a642022-12-22T01:19:27ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122020-09-011110.3389/fphar.2020.575437575437Hypersensitivity Reactions to Multiple Iodinated Contrast MediaInmaculada Doña0Gádor Bogas1María Salas2Almudena Testera3Esther Moreno4Jose Julio Laguna5María José Torres6María José Torres7María José Torres8Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, SpainAllergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, SpainAllergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, SpainAllergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, SpainAllergy Unit, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca-IBSAL, ARADyAL, Salamanca, SpainAllergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University. ARADyAL, Madrid, SpainAllergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, SpainNanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, SpainDepartamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, SpainThe incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer after ICM administration. The diagnosis of HSRs to ICM is complex as skin test (ST) sensitivity ranges widely, and drug provocation test (DPT) protocols are heterogeneous. In this manuscript, we describe the clinical characteristics of a series of patients confirmed as HSR to ICM and the diagnosis procedure carried out, looking into those cases confirmed as HSRs to multiple ICMs. For this purpose, we prospectively evaluated patients suggestive of HSRs to ICMs and classified them as IRs or NIRs. STs were carried out using a wide panel of ICMs, and in those with a negative ST, a single-blind placebo controlled DPT was performed with the culprit. If ST or DPT were positive, then tolerance was assessed with an alternative negative ST ICM. We included 101 cases (12 IRs and 89 NIRs) confirmed as allergic. Among them, 36 (35.64%) cases were allergic to more than one ICM (8 IRs and 28 NIRs). The most common ICM involved were iomeprol and iodixanol. Although not statistically significant, the percentage of patients reporting anaphylaxis was higher in patients allergic to multiple ICMs compared with patients allergic to a single ICM (50 vs. 25%). Likewise, the percentage of positive results in STs was higher in patients allergic to multiple ICMs compared with those allergic to a single ICM (for IR 62.5 vs. 25%, p > 0.05; and for NIR, 85.71 vs. 24.59%, p < 0.000). In cases allergic to more than one ICM, DPT with negative-ST ICM was positive in more than 60% (24/36) of cases. Therefore, allergy to multiple ICMs is common, associated to severe reactions in IRs, and confirmed frequently by positive STs. The allergological work-up should include DPT not only to establish the diagnosis but also to identify safe alternative ICM, even if ICM is structurally unrelated and ST is negative. More studies are needed to clarify mechanisms underlying cross-reactivity among ICMs.https://www.frontiersin.org/article/10.3389/fphar.2020.575437/fullanaphylaxisdrug allergydrug provocation testexanthemahypersensitivityiodinated contrast media |
| spellingShingle | Inmaculada Doña Gádor Bogas María Salas Almudena Testera Esther Moreno Jose Julio Laguna María José Torres María José Torres María José Torres Hypersensitivity Reactions to Multiple Iodinated Contrast Media Frontiers in Pharmacology anaphylaxis drug allergy drug provocation test exanthema hypersensitivity iodinated contrast media |
| title | Hypersensitivity Reactions to Multiple Iodinated Contrast Media |
| title_full | Hypersensitivity Reactions to Multiple Iodinated Contrast Media |
| title_fullStr | Hypersensitivity Reactions to Multiple Iodinated Contrast Media |
| title_full_unstemmed | Hypersensitivity Reactions to Multiple Iodinated Contrast Media |
| title_short | Hypersensitivity Reactions to Multiple Iodinated Contrast Media |
| title_sort | hypersensitivity reactions to multiple iodinated contrast media |
| topic | anaphylaxis drug allergy drug provocation test exanthema hypersensitivity iodinated contrast media |
| url | https://www.frontiersin.org/article/10.3389/fphar.2020.575437/full |
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