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McClatchy J, Yap T, Nirenberg A, Scardamaglia L. Fixed drug eruptions – the common and novel culprits since 2000. J Dtsch Dermatol Ges 2022; 20:1289-1302. [DOI: 10.1111/ddg.14870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Jessica McClatchy
- Dermatology Department The Royal Melbourne Hospital Melbourne Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australia
| | - Tami Yap
- Dermatology Department The Royal Melbourne Hospital Melbourne Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australia
- Melbourne Dental School The University of Melbourne Melbourne Australia
| | - Alexander Nirenberg
- Dorevitch Pathology Melbourne Australia
- Australasian College of Cutaneous Oncology Melbourne Australia
| | - Laura Scardamaglia
- Dermatology Department The Royal Melbourne Hospital Melbourne Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australia
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2
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McClatchy J, Yap T, Nirenberg A, Scardamaglia L. Fixes Arzneimittelexanthem – häufige und neue Auslöser seit dem Jahr 2000. J Dtsch Dermatol Ges 2022; 20:1289-1303. [DOI: 10.1111/ddg.14870_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/13/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica McClatchy
- Dermatology Department The Royal Melbourne Hospital Melbourne Australien
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australien
| | - Tami Yap
- Dermatology Department The Royal Melbourne Hospital Melbourne Australien
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australien
- Melbourne Dental School The University of Melbourne Melbourne Australien
| | - Alexander Nirenberg
- Dorevitch Pathology Melbourne Australien
- Australasian College of Cutaneous Oncology Melbourne Australien
| | - Laura Scardamaglia
- Dermatology Department The Royal Melbourne Hospital Melbourne Australien
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australien
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Radiocontrast Media Hypersensitivity Reactions in Children. Medicina (B Aires) 2022; 58:medicina58040517. [PMID: 35454356 PMCID: PMC9028608 DOI: 10.3390/medicina58040517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/26/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Hypersensitivity reactions to radiocontrast media seem to be rare in children. Furthermore, the use of radiocontrast media in children remains quite safe in terms of the severity of reactions. Since pediatric guidelines are lacking, the diagnostic workup employed in adults could be adapted to children, taking into account that results have not yet been validated in this age group. Specific protocols for risk stratification and management of severe reactions have been proposed so far.
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Woodruff CM, Botto N. The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications. Clin Rev Allergy Immunol 2022; 62:548-561. [PMID: 35113364 PMCID: PMC9156465 DOI: 10.1007/s12016-022-08924-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/19/2022]
Abstract
Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life threatening. We review the literature on ideal patch testing technique for specific CADRs. Testing should be performed approximately 3 months after the resolution of the eruption using standard patch testing techniques. Commercially available patch test preparations are available for a minority of drugs, so in most cases, testing should be performed with the drug at various recommended concentrations and in different vehicles. Testing to all known excipients, such as dyes, vehicles and preservatives is also important. Immunosuppressive medications should be discontinued or down titrated to the lowest tolerable dose to decrease the risk of false negative reactions. We provide an overview of expert recommendations and extant evidence on the utility of patch testing for identifying the culprit drug in common CADRs and for specific drug or drug classes. Overall, there appears to be significant variability in the patch test positivity of different drugs, which is likely the result of factors intrinsic to the drug such as dermal absorption (as a function of lipophilicity and molecular size) and whether the drug itself or a downstream metabolite is implicated in the immune reaction. Drugs with high patch test positivity rates include beta-lactam antibiotics, aromatic anticonvulsants, phenytoin, and corticosteroids, among others. Patch testing positivity varies both as a function of the drug and type of CADR. The sum of the evidence suggests that patch testing in the setting of morbilliform eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, and possibly also drug-induced hypersensitivity syndrome, photoallergic and eczematous reactions may be worthwhile, although utility of testing may vary on the specific drug in question for the eruption. It appears to be of limited utility and is not recommended in the setting of other complex CADR, such as SJS/TEN and leukocytoclastic vasculitis.
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Affiliation(s)
| | - Nina Botto
- University of California San Francisco, San Francisco, CA, USA
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5
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Torres MJ, Trautmann A, Böhm I, Scherer K, Barbaud A, Bavbek S, Bonadonna P, Cernadas JR, Chiriac AM, Gaeta F, Gimenez‐Arnau AM, Kang H, Moreno E, Brockow K. Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity. Allergy 2021; 76:1325-1339. [PMID: 33170954 DOI: 10.1111/all.14656] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%-3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re-exposition or drug provocation test should only be done with skin test-negative ICMs. The decision for performing either re-exposition or drug provocation test needs to be taken based on a risk-benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial.
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Affiliation(s)
- María José Torres
- Allergy Unit Regional University Hospital of Malaga‐IBIMA‐UMA‐ARADyAL Malaga Spain
| | - Axel Trautmann
- Department of Dermatology and Allergy University Hospital Würzburg Würzburg Germany
| | - Ingrid Böhm
- Department of Diagnostic, Interventional, and Pediatric Radiology Inselspital University of Bern Bern Switzerland
| | | | - Annick Barbaud
- Service de Dermatologie et Allergologie Sorbonne Université INSERM Institut Pierre Louis d’Epidemiologie et de Sante Publique AP‐HP Sorbonne Universite, Hopital Tenon Paris France
| | - Sevim Bavbek
- Department of Chest Disease Division of Immunology and Allergy School of Medicine Ankara University Ankara Turkey
| | | | | | - Anca Mirela Chiriac
- Department of Pulmonology Division of Allergy Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
| | - Francesco Gaeta
- Allergy Unit Columbus Hospital Agostino Gemelli IRCCS University Hospital Rome Italy
| | - Ana M. Gimenez‐Arnau
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma Barcelona Barcelona Spain
| | - Hye‐Ryun Kang
- Department of Internal Medicine Division of Allergy and Clinical Immunology Seoul National University College of Medicine Seoul Korea
| | - Esther Moreno
- Allergy Unit University Hospital of Salamanca‐IBSAL‐UMA‐ARADyAL Salamanca Spain
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein School of Medicine Technical University of Munich Munich Germany
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6
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Affiliation(s)
- Skylar Klager
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Kenneth Shulman
- Department of Dermatology, New York Medical College, Valhalla, New York
| | - Naveed Sami
- UCF Health, Orlando, Florida.,Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida
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7
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Böhm IB. 30 years of Katayama's article on ionic and non-ionic contrast media: appreciation of well and less known facts of a milestone paper. Quant Imaging Med Surg 2020; 10:2374-2375. [PMID: 33269234 DOI: 10.21037/qims-20-843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ingrid B Böhm
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
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8
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Gavin M, Sharp L, Walker K, Behrens E, Akin R, Stetson CL. Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome. Proc AMIA Symp 2019; 32:601-602. [PMID: 31656435 DOI: 10.1080/08998280.2019.1644147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 01/14/2023] Open
Abstract
A 59-year-old woman with end-stage renal disease presented for suspected Stevens-Johnson syndrome that was ultimately diagnosed as generalized bullous fixed drug eruption (GBFDE) secondary to the administration of iodinated nonpolar radiocontrast. The patient had three previous episodes of a generalized bullous eruption after a thrombectomy, fistulogram, and an arteriovenous fistula revision, all requiring radiocontrast administration. Biopsies taken after previous eruptions demonstrated full-thickness epidermal necrosis, and she was diagnosed with Stevens-Johnson syndrome thought to be due to allopurinol. However, against medical advice she continued taking allopurinol and remained asymptomatic until the current presentation. Based on the clinical appearance and time frame of the eruptions, the patient was diagnosed with GBFDE due to radiocontrast. GBFDE, a rare variant of a fixed drug eruption, can be misdiagnosed as Stevens-Johnson syndrome due to their overlapping features of drug-induced whole-body blisters and variable degrees of epidermal necrosis.
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Affiliation(s)
- Meredith Gavin
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Leigha Sharp
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Kendra Walker
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Emily Behrens
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Russell Akin
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Cloyce L Stetson
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
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Tasker F, Fleming H, McNeill G, Creamer D, Walsh S. Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media. Clin Exp Dermatol 2019; 44:844-860. [DOI: 10.1111/ced.13991] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- F. Tasker
- Department of Dermatology King's College Hospital London UK
| | - H. Fleming
- Department of Radiology St Vincent's University Hospital Dublin Ireland
| | - G. McNeill
- Department of Radiology St Vincent's University Hospital Dublin Ireland
| | - D. Creamer
- Department of Dermatology King's College Hospital London UK
| | - S. Walsh
- Department of Dermatology King's College Hospital London UK
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Nagai H, Nishigori C. A delayed reaction to the magnetic resonance imaging contrast agent gadobutrol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:850-851. [DOI: 10.1016/j.jaip.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Böhm I, Morelli J, Nairz K, Silva Hasembank Keller P, Heverhagen JT. Myths and misconceptions concerning contrast media-induced anaphylaxis: a narrative review. Postgrad Med 2017; 129:259-266. [DOI: 10.1080/00325481.2017.1282296] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Radiology Laboratory, Department Clinical Research, University of Bern, Bern, Switzerland
| | - John Morelli
- Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA
| | - Knud Nairz
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | | | - Johannes T. Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Radiology Laboratory, Department Clinical Research, University of Bern, Bern, Switzerland
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Abe S, Fukuda H, Tobe K, Ibukuro K. Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium. Eur Radiol 2015; 26:2148-54. [DOI: 10.1007/s00330-015-4028-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/06/2015] [Accepted: 09/14/2015] [Indexed: 05/28/2023]
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Shim J, Chung S, Kim GW, Sohn KH, Kim JY, Kang HR. Iodinated contrast media-induced fixed drug eruption. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.5.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jisu Shim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Soojie Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Gun-Woo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Hee Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea
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Böhm I, Heverhagen JT, Klose KJ. Classification of acute and delayed contrast media-induced reactions: proposal of a three-step system. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:537-41. [DOI: 10.1002/cmmi.1475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic Radiology; Philipps University of Marburg; Marburg; Germany
| | | | - Klaus J. Klose
- Department of Diagnostic Radiology; Philipps University of Marburg; Marburg; Germany
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16
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Hypersensitivity reactions and contrast medium injection: Are they always related? Eur J Radiol 2011; 80:368-72. [DOI: 10.1016/j.ejrad.2010.12.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/17/2010] [Indexed: 11/23/2022]
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Cha SH, Kim HS, Lee JY, Kim HO, Park YM. Fixed Drug Eruption due to Iopromide (Ultravist®). Ann Dermatol 2011; 23 Suppl 1:S33-5. [PMID: 22028567 PMCID: PMC3199417 DOI: 10.5021/ad.2011.23.s1.s33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/26/2010] [Accepted: 08/26/2010] [Indexed: 11/09/2022] Open
Abstract
A 69-year-old male presented with several painful erythematous patches on both palms and trunk several days after receiving iopromide (Ultravist®, Shering, Berlin, Germany). A fixed drug eruption (FDE) due to iopromide was suspected clinically. However, at that time, the patch test with iopromide at the lesion site gave negative results. Three years later, the patient was mistakenly administered iopromide again and patches with vesicles recurred on the same sites as well as on the genitalia. This episode was repeated once again after 1 year. In all episodes, the skin lesion resolved after application of topical steroids. Although a patch test with iopromide was negative in our case, we made a diagnosis of FDE due to iopromide because the skin lesions occurred again at the previously involved area after re-exposure to iopromide. To date, only three cases of FDE caused by non-ionic monomers have been documented in the English literature. Herein, we report on an interesting case of FDE caused by iopromide.
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Affiliation(s)
- Sang Hee Cha
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Moneret-Vautrin DA, Codreanu F, Drouet M, Plaud B, Karila C, Valfrey J, Debaene B, Malinovsky JM, Mertes JM. [Allergologic screening and management of patients with previous self-reported hypersensitivity reactions. Société française d'anesthésie et réanimation. Société française d'allergologie]. ACTA ACUST UNITED AC 2011; 30:246-63. [PMID: 21397445 DOI: 10.1016/j.annfar.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D-A Moneret-Vautrin
- Service de médecine interne, immunologie clinique et allergologie, hôpital central, avenue du Maréchal de-Lattre-de-Tassigny, Nancy cedex, France.
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Böhm I. Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity. Br J Radiol 2011; 84:672; author reply 673. [DOI: 10.1259/bjr/65388056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Frías M, Fernández E, Audicana MT, Longo N, Muñoz D, Reyes SM. Fixed drug eruption caused by iodinated contrast media. Contact Dermatitis 2011; 65:43-4. [DOI: 10.1111/j.1600-0536.2010.01816.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Le Beller C, Fraitag S, Jacquot C, Lillo-Le Louët A, Auffret N. Érythème pigmenté fixe à l’iodixanol (Visipaque®). Ann Dermatol Venereol 2008; 135:684-5. [DOI: 10.1016/j.annder.2008.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
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Contrast-media-induced hypersensitivity or allergic/allergic-like reactions? Suggestion for a more appropriate use of the nomenclature. Eur J Clin Pharmacol 2008; 64:931-2; author reply 933-4. [DOI: 10.1007/s00228-008-0527-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 06/13/2008] [Indexed: 11/26/2022]
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23
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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