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Schmid AA, Hungerbühler MN, Lombardo P, Boehm IB. Intradermal testing of iodinated contrast media: Should we test up to pure or with diluted compounds only? Fundam Clin Pharmacol 2024; 38:789-798. [PMID: 38481365 DOI: 10.1111/fcp.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/15/2023] [Accepted: 02/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Intradermal testing (IDT) with iodinated contrast media (ICMs) is an established diagnostic tool in patients with ICM hypersensitivity. Currently, it is unclear which test concentration is the more useful one, up to pure or up to 1:10 diluted ICMs. METHODS We searched the literature database PubMed for eligible papers dealing with ICM allergy and their IDT results. We analyzed the data presented by the papers and compared the pooled groups tested with diluted and undiluted ICMs. RESULTS We identified 29 eligible original papers, and extracted data of 1137 patients that formed the study population. Although in the cohort tested with diluted ICMs the number of tested ICMs was greater, the percentage of positive tests was significantly less (9.0% vs. 24.7%; P < 0.0001; OR 0.30 [0.26-0.34]). The frequency of positive tested culprit ICMs was also lesser in the group tested with diluted ICMs (31.0% vs. 72.5%; P < 0.0001; OR 0.17 [0.12-0.23]). The number of drug provocation tests (DPTs) was greater in patients with diluted IDTs (374 vs. 89; P < 0.0001; OR 2.54 [1.93-3.36]). We detected an increased sensitivity in patients with undiluted tests (0.774 vs. 0.282) and a nearly identical specificity in both groups (1 vs. 0.983). CONCLUSIONS For the first time, we show that IDT up to pure ICM concentrations is superior to using diluted ICMs only. Possibly, we can reduce the number of DPTs when performing IDTs with pure ICMs. In the undiluted group, there were no hints for skin irritations or unspecific test reactions.
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Affiliation(s)
- Adrian A Schmid
- Department of Radiology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Martin N Hungerbühler
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paolo Lombardo
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Ingrid B Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
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Copaescu AM, Li L, Blumenthal KG, Trubiano JA. How to Define and Manage Low-Risk Drug Allergy Labels. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1095-1106. [PMID: 38724164 DOI: 10.1016/j.jaip.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 06/06/2024]
Abstract
Risk stratification in drug allergy implies that specific risk categories (eg, low, moderate, and high) classify historical drug hypersensitivity reactions. These risk categories can be based on reaction phenotypic characteristics, the timing of the reaction and evaluation, the required reaction management, and individual characteristics. Although a multitude of frameworks have been described in the literature, particularly for penicillin allergy labels, there has yet to be a global consensus, and approaches continue to vary between allergy centers. Immune-mediated drug allergies can sometimes be confirmed using skin testing, but a negative drug challenge is required to demonstrate tolerance and remove the allergy from the electronic health record ("delabel" the allergy). Even for quintessential IgE-mediated drug allergy, penicillin allergy, recent data reveal that a direct oral challenge, without prior skin testing, is an appropriate diagnostic strategy in those who are considered low-risk. Drug allergy pathogenesis and clinical manifestations may vary depending on the culprit drug, and as such, the optimal approach should be based on risk stratification that considers individual patient and reaction characteristics, the likely hypersensitivity reaction phenotype, the drug class, and the patient's clinical needs. This article will describe low-risk drug allergy labels, focusing on β-lactam and sulfonamide antibiotics, nonsteroidal anti-inflammatory drugs, iodinated contrast media, and common chemotherapeutics. This review will also address practical management approaches using currently available risk stratification and clinical decision tools.
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Affiliation(s)
- Ana Maria Copaescu
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, Austin Health, the University of Melbourne, Heidelberg, VIC, Australia; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada; The Research Institute of the McGill University Health Centre, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada.
| | - Lily Li
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Wash
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Jason A Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia; Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
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Xu W, Chen M, Liu S, Su Y, Zhang Y. Transient pulmonary and gastric bleeding after iopamidol administration in a patient with marginal zone lymphoma: a case report. BMC Pulm Med 2024; 24:198. [PMID: 38649880 PMCID: PMC11036599 DOI: 10.1186/s12890-024-02993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Iopamidol is a non-ionic, water-soluble iodine contrast agent that is considered safe for intravenous or intra-arterial administration and is widely used both in the general population and in patients undergoing oncological treatment. While adverse reactions to iopamidol have been documented, to date, no pulmonary and gastric hemorrhages induced by iopamidol have been reported in oncology patients. We report the first case of this complication. CASE PRESENTATION We report the case of a 60-year-old woman with marginal zone lymphoma who was receiving antineoplastic therapy. As part of the investigation for the condition, she underwent chest enhancement CT with iopamidol. Shortly thereafter(within five minutes), she experienced hemoptysis and hematemesis. She was intubated and admitted to the intensive care unit. Pre- and post-contrast images demonstrated the course of the hemorrhage. Flexible bronchoscopy and gastroscopy on the following day showed no active bleeding, and the patient recovered completely after antiallergy treatment. We speculate that contrast-induced hypersensitivity was the most likely cause of the transient pulmonary and gastric bleeding. CONCLUSION Although rare, the complications of iopamidol, which may cause allergic reactions in the lungs and stomach, should be considered.
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Affiliation(s)
- Weixian Xu
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Miaozhen Chen
- Foshan Clinical Medical School of Guangzhou University of Chinese Medicine, 3 Sanyou South Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Songtao Liu
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Yi Su
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China
| | - Yunhai Zhang
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China.
- Department of Critical Care Medicine, Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Chancheng District, 528000, Foshan City, Guangdong Province, China.
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Ghiordanescu IM, Molinari N, Ciocănea-Teodorescu I, Schrijvers R, Motei C, Forsea AM, Demoly P, Chiriac AM. Skin Test Reactivity Patterns in Patients Allergic to Iodinated Contrast Media: A Refined View. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:705-713.e6. [PMID: 39056227 DOI: 10.1016/j.jaip.2023.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/30/2023] [Accepted: 10/23/2023] [Indexed: 07/28/2024]
Abstract
BACKGROUND Two-dimensional (2D) classifications of iodinated contrast media (ICM) are insufficient to explain the observed skin test (ST) reactivity patterns in patients with drug hypersensitivity reactions (DHRs) to ICM. OBJECTIVE To refine the current view on allergic DHRs to ICM by analyzing ST reactivity patterns in patients with previous reactions to ICM. METHODS Patients with a history of DHR to ICM and positive STs, who presented at the University Hospital of Montpellier between 2004 and 2022, were included in the study. The relative difference between every two ICM products was measured by Manhattan distance and odds ratios were computed for all pairs of products in the immediate reaction (IR) and non-immediate reaction (NIR) ST groups. RESULTS A total of 181 patients were included in the study. Odds ratio analysis identified significant associations between classical cross-reactive ICM, such as iohexol-ioversol, iohexol-iomeprol, iomeprol-ioversol, and iohexol-iodixanol in the IR ST group and iohexol-ioversol, iopromide-iohexol, and iomeprol-ioversol in the NIR ST group. We also identified uncommon associations, such as ioxitalamate-amidotrizoate in the IR ST group and amidotrizoate-iopamidol and amidotrizoate-ioxitalamate in the NIR ST group. The results were reflected by the Manhattan distance, which suggested the existence of clusters containing the same classically associated ICM as well as uncommon associations, which we hypothesize to be related to similarities in the 3D structure of the respective ICM. CONCLUSIONS Current chemical (2D) classifications cannot explain all observed ST reactivity patterns. Whether the 3D structure can be integrated into the current classifications to interpret the observed ST reactivity patterns and predict tolerance to alternative ICM requires further research.
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Affiliation(s)
- Ileana-Maria Ghiordanescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Dermatology and Allergy Clinic, Elias University Emergency Hospital, Bucharest, Romania.
| | - Nicolas Molinari
- Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Division of Medical Information, La Colombiere University Hospital of Montpellier, Montpellier, France
| | - Iuliana Ciocănea-Teodorescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Victor Babeș National Institute of Pathology, Bucharest, Romania
| | - Rik Schrijvers
- Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Cezara Motei
- Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Ana-Maria Forsea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dermatology and Allergy Clinic, Elias University Emergency Hospital, Bucharest, Romania
| | - Pascal Demoly
- Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Anca Mirela Chiriac
- Institut Desbrest d'Épidémiologie et de Santé Publique, UMR UA11, University of Montpellier-INSERM, Montpellier, France; Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
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Barbaud A, Garvey LH, Torres M, Laguna JJ, Arcolaci A, Bonadonna P, Scherer Hofmeier K, Chiriac AM, Cernadas J, Caubet JC, Brockow K. EAACI/ENDA position paper on drug provocation testing. Allergy 2024; 79:565-579. [PMID: 38155501 DOI: 10.1111/all.15996] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
In drug hypersensitivity, drug provocation testing (DPT), also called drug challenge, is the gold standard for investigation. In recent years, risk stratification has become an important tool for adjusting the diagnostic strategy to the perceived risk, whilst still maintaining a high level of safety for the patient. Skin tests are recommended before DPT but may be omitted in low-risk patients. The task force suggests a strict definition of such low-risk patients in children and adults. Based on experience and evidence from studies of allergy to beta-lactam antibiotics, an algorithm on how to adjust DPT to the risk, and when to omit skin tests before DPT, is presented. For other antibiotics, non-steroidal anti-inflammatory drugs and other drugs, skin tests are poorly validated and DPT is frequently necessary. We recommend performing DPT with chemotherapeutics and biologicals to avoid unnecessary desensitization procedures and DPT with skin tests negative contrast media. We suggest DPT with anesthetics only in highly specialized centers. Specifics of DPT to proton pump inhibitors, anticonvulsants and corticosteroids are discussed. This position paper provides general recommendations and guidance on optimizing use of DPT, whilst balancing benefits with patient safety and optimizing the use of the limited available resources.
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Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Tenon, Service de dermatologie et allergologie, Paris, France
| | - Lene Heise Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Torres
- Allergy Unit, Regional University Hospital of Malaga-IBIMA-UMA-ARADyAL, Malaga, Spain
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, ARADyAL, REI, Madrid, Spain
| | - Alessandra Arcolaci
- Immunology Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Patrizia Bonadonna
- Allergy Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Kathrin Scherer Hofmeier
- Allergy and Dermatology, Cantonal Hospital Aarau, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Anca Mirela Chiriac
- Allergy Unit, University Hospital of Montpellier and IDESP, UMR UA11, Univ. Montpellier - INSERM, Montpellier, France
| | - Josefina Cernadas
- Hospital Lusíadas, Porto, Portugal
- Centro Hospitalar Universitário H. S. João, Porto, Portugal
| | - Jean Christoph Caubet
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine and Health, Munich, Germany
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Lee JH, Yoo Y, Kim SR, Lee JH, Kim SY, An J, Park SY, Park HK, Kim S, Song WJ, Yang MS, Kwon HS, Park HK, Lee J, Hur GY, Ko GJ, Kim SH, Kim SH, Ye YM, Koh YI, Lee BJ, Cho YS, Yong HS, Kim TB. Skin Test-Guided Strategy to Select Alternative Iodinated Contrast Media in Patients With Immediate Hypersensitivity Reaction: A Prospective Confirmative Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3454-3462.e1. [PMID: 37543085 DOI: 10.1016/j.jaip.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 05/30/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Iodinated contrast media (ICM) are a common cause of drug-induced immediate hypersensitivity reaction (IHR). Repeated use of ICM is often necessary; therefore, a standardized protocol to prevent recurrence of IHR is required. OBJECTIVE We aimed to propose an intradermal skin test (IDT)-guided strategy for previous reactors to prevent recurrence of IHR. METHODS We conducted a prospective multicenter study from May 2018 to December 2020 and recruited patients who had experienced IHR to ICM. Once enrolled, the participants underwent IDT with a causative ICM. The alternatives for reexposure were selected using the following protocol: (1) if the IDT with the culprit ICM was positive, further skin tests with other available ICM were conducted to choose IDT-negative agents as alternatives, and (2) if the IDT with the culprit ICM was negative, a randomly changed ICM was used without additional skin tests. The recurrence and severity of hypersensitivity were assessed in subsequent computed tomography examinations. Premedication was administered according to the severity of the index event in all cases. RESULTS A total of 496 participants were enrolled, and 299 were reexposed to ICM. Among 269 participants who followed the protocol, 228 (84.8%) completed computed tomography examinations without adverse reactions, and IHR recurred in 16 of 30 participants (53.3%) who did not follow the protocol (P < .001). In addition, application of the protocol reduced the severity of IHR in recurred cases (P = 0.003). CONCLUSIONS Our IDT-guided strategy not only reduced recurrence of IHR to ICM but also mitigated the severity in recurred cases. This provides evidence for recommending an IDT to diagnose ICM allergy and find safe alternatives.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngsang Yoo
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Division of Pulmonary and Allergy and Critical Care Medicine, Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Sung-Ryeol Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seo-Young Kim
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin An
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, University of Kyung Hee College of Medicine, Seoul, Korea
| | - So-Young Park
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han-Ki Park
- Department of Allergy and Clinical Immunology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sujeong Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Jaechun Lee
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Gyu-Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Gang-Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Il Koh
- Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Caron J, Graf S, Delebarre‐Sauvage C. Immediate hypersensitivity reactions to iodinated contrast media: The diagnosis of allergy by skin testing. Clin Transl Allergy 2022; 12:e12214. [PMID: 36573311 PMCID: PMC9720225 DOI: 10.1002/clt2.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Among 74 patients with an immediate hypersensitivity reaction (IHR) to iodinated contrast media (ICM), the rate of allergic patients confirmed by positive prick test or diluted intradermal test (IDT) was 8.1%. 12.5% of re-exposed patients had a recurrent IHR despite negative skin tests. Investigations on pure IDT to ICM and development of drug provocation test may provide additional safety nets to uncover recurrent ICM reactors. Agreements among allergists are needed to unify practices.
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Affiliation(s)
- Juliette Caron
- Service d'allergologie et d’éducation thérapeutiqueHôpital Saint Vincent‐de‐PaulLille CedexFrance
| | - Sahara Graf
- Délégation à la Recherche Clinique et à l’InnovationUnité de BiostatistiquesHôpital Saint PhilibertLomme CedexFrance
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Ahn KM, Ahn YH, Cho MK, Kang DY, Lee SY, Kang HR. Validation of Practical Pathway in Patients With Anaphylaxis to Low Osmolar Contrast Media: A Retrospective Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2685-2692.e2. [PMID: 35413472 DOI: 10.1016/j.jaip.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND An optimal strategy for choosing safe alternative low osmolar contrast media (LOCM) has not yet been established in patients with a history of LOCM-induced anaphylaxis. OBJECTIVES To validate the practical pathway in patients with anaphylaxis to LOCMs and to compare 2 different doses of challenge testing with skin test-negative LOCM. METHODS A retrospective cohort study was performed in patients with LOCM-induced anaphylaxis. Patients were challenged with intravenous LOCMs showing negativity in the skin test according to 2 different protocols: low-dose and high-dose (maximum dose 10 and 30 mL, respectively). Challenge-negative LOCMs were selected for use during computed tomography scans, and patients received intravenous pretreatment with 4 mg chlorpheniramine and 40 mg methylprednisolone. RESULTS Of the 110 challenge tests, there were 4 (3.6%) positive challenges. Among 106 enhanced computed tomography scans performed using challenge-negative LOCMs, breakthrough reactions occurred in 8 (7.6%). Breakthrough reaction rates were not statistically different between the 2 protocols (8.9% and 6.0% in the low-dose challenge and the high-dose challenge, respectively). Compared with the low-dose protocol, the number needed to test of the high-dose challenge test decreased 2.5-fold. Moreover, none of the patients in the high-dose challenge group incurred severe reactions during computed tomography scans with challenge-negative LOCM, whereas 80% of reactions were severe in the low-dose challenge group. CONCLUSIONS We validated a pathway consisting of a battery of skin testing to LOCMs and challenge with skin test-negative LOCM in patients with LOCM-induced anaphylaxis.
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Affiliation(s)
- Kyung-Min Ahn
- 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, Korea
| | - Yoon Hae Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Cho
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Dong Yoon Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Suh Young Lee
- 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, 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, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea.
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9
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Chiu TM, Chu SY. Hypersensitivity Reactions to Iodinated Contrast Media. Biomedicines 2022; 10:biomedicines10051036. [PMID: 35625773 PMCID: PMC9138609 DOI: 10.3390/biomedicines10051036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
At present, iodinated contrast media (ICM) are mostly non-ionic, have low osmolality, and are safe. Even if adverse drug reactions (ADRs) occur, most are chemo-toxic symptoms and require only observation or H1 antihistamines. However, rare, unpredictable, and even life-threatening hypersensitivity can still occur. The aim of this review is to summarize the issues that all relevant staff need to know about and be able to respond to. The most significant risk factor for ICM hypersensitivity is a history of ICM hypersensitivity. For high-risk populations, we must cautiously weigh the advantages and disadvantages of premedication and be aware that breakthrough reactions may still occur. The best policy for patients with a history of severe ICM hypersensitivity is to avoid the same ICM. If ICM are inevitable, skin tests, in vitro tests, and drug provocation tests may help to find a feasible alternative that is safer. The severity of the hypersensitivity is correlated with the positivity rate of these tests, so there is no need for further investigations for patients with only mild reactions. We should also keep in mind that even excipients in ICM may induce hypersensitivity. Detailed, standardized documentation is essential for correct diagnosis and the prevention of future occurrence.
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Affiliation(s)
- Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua City 50073, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Correspondence:
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Chompunud Na Ayudhya C, Ali H. Mas-Related G Protein–Coupled Receptor-X2 and Its Role in Non-immunoglobulin E–Mediated Drug Hypersensitivity. Immunol Allergy Clin North Am 2022; 42:269-284. [PMID: 35469618 PMCID: PMC9674431 DOI: 10.1016/j.iac.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A diverse group of Food and Drug Administration-approved cationic drugs including antibiotics, neuromuscular blocking drugs, opioids, antidepressants, and radiocontrast media activate mast cells and cause hypersensitivity reactions by both an immunoglobulin E IgE-dependent and independent manner. The recent discovery that these drugs activate mast cells via the G protein-coupled receptor known as Mas-related GPCR-X2 (MRGPRX2) has represented a paradigm shift of how drug hypersensitivity reactions are viewed. This article provides an overview of the current status of the role of MRGPRX2 on non-IgE-mediated drug hypersensitivity. Potential risk factors and evaluation for suspected MRGPRX2-mediated drug reactions are also discussed.
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Affiliation(s)
| | - Hydar Ali
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA 19104, USA.
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11
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van der Molen AJ, Dekkers IA, Bedioune I, Darmon-Kern E. A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol in more than 57,000 patients: part 1-intravenous administration. Eur Radiol 2022; 32:5532-5545. [PMID: 35312790 PMCID: PMC9279198 DOI: 10.1007/s00330-022-08636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intravenous (IV) administration of ioversol. MATERIALS AND METHODS A systematic literature search (1980-2021) of studies documenting IV use of ioversol and presence or absence of ADRs, HSRs, or PC-AKI was performed. Key information including patients' characteristics, indication and dose of ioversol, safety outcome incidence, intensity and seriousness were extracted. RESULTS Thirty-one studies (> 57,000 patients) were selected, including 4 pediatric studies. The incidence of ADRs in adults was reported in 12 studies from ioversol clinical development with a median (range) of 1.65% (0-33.3%), and 3 other studies with an incidence between 0.13 and 0.28%. The incidence of HSRs (reported in 2 studies) ranged from 0.20 to 0.66%, and acute events (4 studies) from 0.23 to 1.80%. Severe reactions were rare with a median (range) of 0 (0-4%), and none were reported among pediatric patients. The incidence of ADRs and HSRs with ioversol, especially those of severe intensity, was among the lowest in studies comparing different iodinated contrast media (ICM) of the same class. PC-AKI incidence was variable (1-42% in 5 studies); however, ioversol exposure per se did not increase the incidence. CONCLUSIONS When administered by the IV route, ioversol has a good safety profile comparable to that of other ICM within the same class, with a low incidence of severe/serious ADRs overall, and particularly HSRs. PC-AKI incidence does not seem to be increased compared to patients who did not receive ioversol. Further well-designed studies are warranted to confirm these results. KEY POINTS • Ioversol has a good safety profile in adult and pediatric patients when IV administered. • ADR and HSR incidence with ioversol, especially those of severe intensity, was among the lowest compared to other ICM. • IV administration of ioversol per se did not increase PC-AKI incidence.
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Affiliation(s)
- Aart J. van der Molen
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Ilona A. Dekkers
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Ibrahim Bedioune
- Clinical Development Department, Guerbet, Roissy CDG Cedex, France
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12
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Schmid AA, Morelli JN, Hungerbühler MN, Boehm IB. Cross-reactivity among iodinated contrast agents: should we be concerned? Quant Imaging Med Surg 2021; 11:4028-4041. [PMID: 34476187 DOI: 10.21037/qims-20-1325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
Background Although several papers deal with "cross-reactivity" in patients with iodinated contrast medium (ICM) hypersensitivity reactions (HSRs), there is no in-depth knowledge of this phenomenon. To define ICM-groups as potential reaction partners and to identify any potential clinical relevance in patients with ICM-HSRs. Methods The literature database PubMed was searched for eligible papers dealing with ICM-allergy and "cross-reactivity". The data presented by the papers was analyzed and individual patient data was extracted for re-evaluation based on a definition for both 'polyvalent reactivity' and 'cross-reactivity' as well as for chemical structure-dependent ICM-groups. Results Twenty-five original papers (with n=340 extracted patients) formed the study population. Incidences of polyvalent reactivity were non-significantly higher than incidences of cross-reactivity (both range from 0% to 100%). Crossover evaluation in reaction pairings (culprit ICM A with ICM B versus culprit ICM B with ICM A) showed concordance of only 30%. Data support rather non-cross-reactivity (individual reaction pattern) than cross-reactivity constellations. Conclusions The obtained results favour an individual reaction pattern, rather than a reactivity driven by chemical structures and so-called cross-reactivity.
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Affiliation(s)
- Adrian A Schmid
- Department of Orthopaedics and Traumatology, Spital Altstaetten, Altstaetten, Switzerland
| | - John N Morelli
- Department of Radiology, St. John's Medical Center Tulsa, OK, USA
| | - Martin N Hungerbühler
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Ingrid B Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
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13
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Joseph JP, Domino P, Bird V, Sharma N, Ford S, Caruso LJ. Outcomes in patients with known contrast allergy undergoing contrast-enhanced endourological procedures: a retrospective cohort study. J Endourol 2021; 35:1857-1862. [PMID: 34088217 DOI: 10.1089/end.2021.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intravenous administration of iodinated contrast agents carries the risk of allergic reaction, yet this risk is unclear with administration into the urinary tract. We sought to evaluate patients with known contrast, iodine, or shellfish allergies for allergic response when undergoing urologic imaging requiring intraluminal, urinary tract contrast administration. MATERIALS AND METHODS We retrospectively reviewed consecutive patients undergoing endourologic procedures from 2010 to 2015 at our institution. Clinical records were reviewed for demographics, medical history, allergies, procedure details, fluids administered, anesthetic and pharmacologic agents administered, and continuous monitoring parameters. Patients with known allergies to iodine, shellfish, and/or contrast were identified and evaluated for clinical or hemodynamic signs of allergy. A convenience sample of 50 patients without allergy history was used as a comparison group. RESULTS We identified 1,405 procedures involving 1,000 consecutive patients. Procedures included retrograde pyelograms and antegrade nephrostograms. Eighty-six cases involving 58 patients with contrast, iodine, or shellfish allergies were identified. Of those with contrast allergy history, 18 (20.1%) cases involved patients with a history of anaphylactic reaction. Of these, 11 (61%) received steroid prophylaxis. No patients in either group (Allergy, No Allergy) were identified as having an allergic reaction during the procedure. There were no statistically significant differences in intraoperative intravenous fluids (p=0.931), procedure duration (p=0.747), or vasopressor use (p=0.973) between groups. Due to the zero event rate of contrast allergy, we used the Hanley and Lippman-Hand method, which places true population risk (95% confidence interval) of a significant event at less than 3.5%. CONCLUSIONS In 86 cases involving patients with a history of contrast allergy, we found no evidence of clinically significant allergic reaction to intraluminal endourologic contrast administration under continuous anesthesia monitoring. The risk of significant reactions to contrast administered within the urinary tract appears to be low in these patients, regardless of prophylaxis.
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Affiliation(s)
- Jason P Joseph
- University of Florida College of Medicine, 12233, Department of Urology, 1600 SW Archer Road, Gainesville, Florida, United States, 32610;
| | - Paula Domino
- University of Florida College of Medicine, 12233, Department of Urology, Gainesville, Florida, United States;
| | - Vincent Bird
- University of Florida College of Medicine, 12233, Department of Urology, Gainesville, Florida, United States;
| | - Nitin Sharma
- University of Florida College of Medicine, 12233, Department of Urology, Gainesville, Florida, United States;
| | - Susan Ford
- University of Florida College of Medicine, 12233, Department of Anesthesiology, Gainesville, Florida, United States;
| | - Lawrence J Caruso
- University of Florida College of Medicine, 12233, Department of Anesthesiology, Gainesville, Florida, United States;
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14
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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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15
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HLA-DRB1*15: 02 Is Associated With Iodinated Contrast Media-Related Anaphylaxis. Invest Radiol 2021; 55:304-309. [PMID: 31985601 DOI: 10.1097/rli.0000000000000644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of severe reaction induced by iodinated contrast media (ICM) has increased over the years with an increasing use of imaging modalities. Although ICM anaphylaxis is rare, it can be life-threatening, but currently, there is no biomarker that can identify individuals at risk of ICM anaphylaxis. OBJECTIVE The aim of this study is to investigate the genetic susceptibility of ICM anaphylaxis. METHODS Patients who had ICM anaphylaxis were enrolled in the study, and their blood samples were collected for genotyping of human leukocyte antigen (HLA)-A, -B, -C, and -DR. The results were compared with those of healthy Korean general population. MRGPRX2 gene in ICM anaphylaxis group was also sequenced and compared with the Korean standard database of genetic polymorphism. RESULTS The frequencies of 3 HLA alleles (B*52:01, C*12:02, and DRB1*15:02) were significantly higher in 47 patients with ICM anaphylaxis. In particular, HLA-DRB1*15:02 was 5 times more frequent in the ICM anaphylaxis group than the Korean general population (34.0% vs 6.6%; odds ratio, 7.306; 95% confidence interval, 3.622-14.740), and this difference was most pronounced in subjects with iohexol-induced anaphylaxis (odds ratio, 16.516; 95% CI, 5.241-52.047; P < 0.0001). Eight single nucleotide polymorphisms were identified in MRGPRX2 gene, but their frequencies were not different in those with ICM anaphylaxis compared with the general Korean population. CONCLUSIONS HLA-DRB1*15:02 is associated with ICM anaphylaxis in the Korean population.
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16
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Doña I, Bogas G, Salas M, Testera A, Moreno E, Laguna JJ, Torres MJ. Hypersensitivity Reactions to Multiple Iodinated Contrast Media. Front Pharmacol 2020; 11:575437. [PMID: 33071787 PMCID: PMC7538657 DOI: 10.3389/fphar.2020.575437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/04/2020] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Inmaculada Doña
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - Gádor Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - María Salas
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - Almudena Testera
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - Esther Moreno
- Allergy Unit, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca-IBSAL, ARADyAL, Salamanca, Spain
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University. ARADyAL, Madrid, Spain
| | - María José Torres
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain.,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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17
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Costantino MT, Romanini L, Gaeta F, Stacul F, Valluzzi RL, Passamonti M, Bonadonna P, Cerri G, Pucci S, Ricci P, Savi E, Galluzzo M, Mauro M, Grassedonio E, Yacoub MR, Reginelli A, Testi S, Ridolo E, Nettis E, Di Leo E, Rossi O, Montuschi P, Incorvaia C, Romano A. SIRM-SIAAIC consensus, an Italian document on management of patients at risk of hypersensitivity reactions to contrast media. Clin Mol Allergy 2020; 18:13. [PMID: 32765190 DOI: 10.1186/s12948-020-00128-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Hypersensitivity reactions (HRs) to contrast media (CM) can be distinguished in immune-mediated (including allergic reactions) and non-immune-mediated reactions, even if clinical manifestations could be similar. Such manifestations range from mild skin eruptions to severe anaphylaxis, making it important for radiologists to know how to identify and manage them. A panel of experts from the Società Italiana di Radiologia Medica e Interventistica (SIRM) and the Società Italiana di Allergologia, Asma e Immunologia Clinica (SIAAIC) provided a consensus document on the management of patients who must undergo radiological investigations with CM. Consensus topics included: the risk stratification of patients, the identification of the culprit CM and of a safe alternative by an allergy workup, as well as the use of premedication and the correct procedure to safely perform an elective (i.e., scheduled) or urgent examination. The most important recommendations are: (1) in all patients, a thorough medical history must be taken by the prescribing physician and/or the radiologist to identify at-risk patients; (2) in patients with hypersensitivity reactions to CM, the radiologist must consider an alternative, non-contrast imaging study with a comparable diagnostic value, or prescribe a different investigation with another class of CM; (3) if such options are not feasible, the radiologist must address at-risk patients to a reference centre for an allergy evaluation; (4) if timely referral to an allergist is not viable, it is recommended to use a CM other than the responsible one, taking into account cross-reactivity patterns; in the case of patients with histories of severe reactions, the presence of an anesthesiologist is also recommended and a premedication is suggested.
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Affiliation(s)
| | - Laura Romanini
- Radiology, Istituti Ospitalieri di Cremona, ASST Cremona, Cremona, Italy
| | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via Moscati n.30, Rome, Italy
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Rocco Luigi Valluzzi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Vatican City, Italy
| | | | - Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Cerri
- Department of Radiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Pucci
- Allergy Unit. General Hospital, Civitanova Marche, Milan, Italy
| | - Paolo Ricci
- Department of Radiology, Oncologiche ad Anatomopatologiche, Azienda Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | - Eleonora Savi
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Michele Galluzzo
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Ospedale San Camillo, Rome, Italy
| | | | - Emanuele Grassedonio
- Department of Radiology, Dipartimento di Biopatologia e Biotecnologie Mediche, Policlinico Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Mona Rita Yacoub
- Allergy and Immunology Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alfonso Reginelli
- Department of Radiology & Radiotherapy, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Sergio Testi
- Allergy and Clinical Immunology Unit, San Giovanni di Dio's Hospital, Florence, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery Clinical, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Eustacchio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, "F. Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Oliviero Rossi
- Allergy Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Paolo Montuschi
- Pharmacology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
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Bisdas T, Koutsias S. Carbon Dioxide As a Standard of Care for Zero Contrast Interventions: When, Why and How? Curr Pharm Des 2020; 25:4662-4666. [PMID: 31782359 DOI: 10.2174/1381612825666191129093823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/25/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Traditional contrast media containing iodine remain the gold standard for vessel visualization during endovascular procedures. On the other hand, their use has several side effects and implications and may cause contrast medium-induced nephropathy. Carbon dioxide (CO2) angiography is an old alternative technique used only for critical patients in order to prevent kidney damages or allergic reactions. Zero contrast procedure: The availability of automated CO2 injectors has led to an increase in the use of CO2 angiography, providing an option for zero contrast interventions, preserving patient renal function and saving costs for the hospital facility. Taking advantage of the properties of CO2 gas, it is possible to improve the performance of some complex procedures such as atherectomy and the detection of type II endoleaks after EVARs. However, a learning curve is needed to get good imaging, and learn about the qualities and limitations of the technique. CONCLUSIONS The use of automatic delivery systems for CO2 angiography appears to be a good choice for the use of CO2 as the first imaging option. The standardization of injection protocols and the extensive use of this technique could lead to significant benefits both for the patient's prospects and health facilities.
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Affiliation(s)
- Theodosios Bisdas
- Clinic of Advanced Endovascular Services, Athens Medical Centre, Athens, Greece
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19
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Hsu Blatman KS, Sánchez-Borges M, Greenberger PA. Anaphylaxis in the Radiology Suite. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1203-1209. [DOI: 10.1016/j.jaip.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
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20
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Trautmann A, Brockow K, Behle V, Stoevesandt J. Radiocontrast Media Hypersensitivity: Skin Testing Differentiates Allergy From Nonallergic Reactions and Identifies a Safe Alternative as Proven by Intravenous Provocation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2218-2224. [DOI: 10.1016/j.jaip.2019.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/10/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022]
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A mast-cell-specific receptor mediates Iopamidol induced immediate IgE-independent anaphylactoid reactions. Int Immunopharmacol 2019; 75:105800. [PMID: 31401386 DOI: 10.1016/j.intimp.2019.105800] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/30/2022]
Abstract
Iopamidol is a radiographic contrast media which caused a very high incidence of anaphylactic reactions. Mast cells are sentinel cells in host defense reactions during immediate hypersensitivity responses and anaphylactic responses. Mas-related G protein-coupled receptor X2 (MRGPRX2) is a kind of mast cell specific receptor, which triggers mast cell degranulation in anaphylactic reactions. Mice MrgprB2 is a homologous gene of MRGPRX2. We sought to better understand the anaphylactic reactions induced by Iopamidol and the mechanisms involving MRGPRX2. The MRGPRX2-related anaphylactic reactions induced by Iopamidol were investigated using the hindpaw swelling and extravasation assay in vivo and a calcium imaging assay was used for mast cell intracellular calcium responses detection and mast cell release of anaphylactic mediators, such as β-hexosaminidase, histamine and TNF-α, was also detected in vitro. The mast cell deficient KitW-sh/W-sh mice and MrgprB2 knockout mice exhibited a reduced Iopamidol-induced inflammation effect compared with wild type mice. Furthermore, human mast cells that express MRGPRX2 were activated by Iopamidol in a dose-dependent manner, meanwhile MRGPRX2 knockdown mast cells showed reduced intracellular calcium responses and anaphylactic mediators release effect. It could be concluded that Iopamidol-induced anaphylactoid reactions were MRGPRX2 mediated to provoke mast cells Ca2+ mobilization and degranulation.
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Maloney E, Iyer RS, Phillips GS, Menon S, Lee JJ, Callahan MJ. Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions. Pediatr Radiol 2019; 49:433-447. [PMID: 30923875 DOI: 10.1007/s00247-018-4306-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing "yes" responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - John J Lee
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
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Soria A, Masson N, Vial-Dupuy A, Gaouar H, Amsler E, Chollet-Martin S, Nicaise-Roland P, Autegarden JE, Barbaud A. Allergological workup with half-dose challenge in iodinated contrast media hypersensitivity. Allergy 2019; 74:414-417. [PMID: 30353926 DOI: 10.1111/all.13638] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Angèle Soria
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
- Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris); INSERM U1135; Paris France
| | - Nathalie Masson
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Amandine Vial-Dupuy
- Service de Pneumologie et d'Allergologie; Hôpital Saint Joseph; Paris France
| | - Hafida Gaouar
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Emmanuelle Amsler
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Sylvie Chollet-Martin
- Hôpitaux Universitaires Paris Nord Val de Seine; Hôpital Bichat; Unité d'Immunologie; Auto-immunité et Hypersensibilités; Paris France
- INSERM; UMR 996; UFR de Pharmacie; Université Paris-Sud; Châtenay-Malabry France
| | - Pascale Nicaise-Roland
- Hôpitaux Universitaires Paris Nord Val de Seine; Hôpital Bichat; Unité d'Immunologie; Auto-immunité et Hypersensibilités; Paris France
| | - Jean-Eric Autegarden
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Annick Barbaud
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
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Iordache AM, Docea AO, Buga AM, Mitrut R, Albulescu D, Zlatian O, Ianosi S, Ianosi G, Neagoe D, Sifaki M, Rogoveanu OC, Branisteanu DE, Calina D. The incidence of skin lesions in contrast media-induced chemical hypersensitivity. Exp Ther Med 2018; 17:1113-1124. [PMID: 30679982 PMCID: PMC6327547 DOI: 10.3892/etm.2018.7056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/08/2018] [Indexed: 12/18/2022] Open
Abstract
Contrast agents are used in radiology to increase the sensibility and specificity of radiological techniques. Some of these compounds have side effects that include organ toxicity (with kidney being the most affected organ) and hypersensitivity reactions. We performed multiple PubMed searches from January, 2008 to January, 2018 for studies regarding adverse reactions to compounds used as contrast agents in imagistic techniques. The initial research identified 929 records written in English. After further excluding 223 non-human studies, 292 articles that had irrelevant designs as reviews, meta-analysis, commentaries, editorials and case reports, 414 studies were selected for retrieval. After reading the abstracts, we excluded 363 studies as they had little relevance to the study. In total, 51 full-articles were assessed for eligible studies to be included. Finally, 20 articles were included in the analysis. In our systematic literature search the incidence of overall skin immediate reactions to iodinated contrast media (ICM) had an incidence between 1.15 and 0.12%, depending on the cohort analyzed in the studies. The percentage of cutaneous manifestations in the cohort that experienced immediate hypersensitivity reactions was between 33.33 and 87.7%. The most frequent skin manifestations were urticaria, rashes, pruritus and limited facial edema. Non-iodinated contrast agents have a safer profile compared with ICM, the incidence of immediate adverse reactions being very low in gadolinium-based contrast agents and other agents used for contrast-enhanced ultrasound. The incidence of delayed reactions was between 10.1 and 0.03%. In the studies analyzed by us the main adverse reactions due to delayed hypersensitivity phenomena were cutaneous manifestations that were present between 70.27 and 100% of the cases. Regarding the risk factors for developing immediate adverse reactions, being female was a predisposing factor accompanied by history of allergy and history of reactions to contrast media. An accurate anamnesis of the patients and a correctly conducted pretreatment can limit the incidence and the severity of the adverse reactions and also can avoid the life occurrence of life-threatening reactions.
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Affiliation(s)
- Andrei Mihai Iordache
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu Mitrut
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dana Albulescu
- Department of Radiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ovidiu Zlatian
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Simona Ianosi
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Gabriel Ianosi
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Sifaki
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Otilia Constantina Rogoveanu
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Clement O, Dewachter P, Mouton-Faivre C, Nevoret C, Guilloux L, Bloch Morot E, Katsahian S, Laroche D, Audebert M, Benabes-Jezraoui B, Benoit Y, Beot S, Berard F, Berthezene Y, Bertrand P, Bouffard J, Bourrain JL, Boyer B, Carette MF, Caron-Poitreau C, Cavestri B, Cercueil JP, Charpin DA, Collet E, Crombe-Ternamian A, Dalmas J, Decoux E, Defrance MF, Delaval Y, Demoly P, Depriester C, Depriester P, Didier A, Drouet M, Dupas B, Dupre-Goetchebeur D, Dzviga C, Fabre C, Ferretti G, Fourre-Jullian C, Girardin P, Giron J, Gouitaa M, Grenier N, Guenard Bilbault L, Guez S, Gunera-Saad N, Heautot JF, Herbin D, Hoarau C, Jacquot C, Julien C, Laborie L, Lambert C, Larroche P, Leclerc X, Lemaitre L, Leynadier F, Lillo-Le-Louet A, Louvel JP, Louvier N, Lucas MM, Meites G, Mennesson N, Metge L, Meunier Y, Monnier-Cholley L, Musacchio M, Nicolie B, Occelli G, Oesterle H, Paisant-Thouveny F, Panuel M, Railhac N, Rety-Jacob F, Rochefort-Morel C, Roy C, Sarlieve P, Sesay M, Sgro C, Taourel P, Terrier P, Theissen O, Topenot I, Valfrey J, Veillon F, Vergnaud MC, Veyret C, Vincent D, Wallaert B, Wessel F, Zins M. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study. EClinicalMedicine 2018; 1:51-61. [PMID: 31193689 PMCID: PMC6537532 DOI: 10.1016/j.eclinm.2018.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors. METHODS Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT. FINDINGS Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups. INTERPRETATION Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.
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Affiliation(s)
- Olivier Clement
- Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France
- Inserm U970 Université Paris Descartes Sorbonne Paris Cité, Laboratoire Imagerie 56 rue Leblanc Paris, FR 75015, France
- Corresponding author at: Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France
| | - Pascale Dewachter
- Assistance Publique Groupe Hospitalier de Paris-Seine Saint Denis, Université Paris Descartes Sorbonne Paris Cité, Anesthésie-Réanimation Chirurgicale, Bondy, FR 93140, France
| | - Claudie Mouton-Faivre
- CHU Nancy-Brabois, Bâtiment Philippe Canton Rue du Morvan, Vandoeuvre-lès-Nancy, FR 54511, France
| | - Camille Nevoret
- Hôpital Européen Georges Pompidou, Unité d'épidémiologie et de recherche clinique Paris, FR 75015, France
| | - Laurence Guilloux
- Laboratoire Biomnis, Immuno Allergologie, 17/19 avenue Tony Garnier Lyon, FR 69357, France
| | - Evelyne Bloch Morot
- Assistance Publique Hôpital Européen Georges Pompidou, Médecine Interne Allergologie Paris, FR 75015, France
| | - Sandrine Katsahian
- Assistance Publique Hôpital Européen Georges Pompidou, Unité d'épidémiologie et de recherche clinique Paris, FR 75015, France
| | - Dominique Laroche
- Centre Hospitalier Universitaire de Caen, Laboratoire d'Hormonologie Caen cedex 9, FR 14033, France
- Université de Caen Basse-Normandie, UFR de Médecine Caen, FR 14000, France
| | | | | | | | - Yves Benoit
- Unité d'Allergologie-Anesthésie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Sylvie Beot
- Service de Radiologie, CHU Brabois, Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Frédéric Berard
- Service d'Immunologie clinique et Allergologie, Pavillon 5 F, Centre Hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite Cedex, France
| | - Yves Berthezene
- Service d'Imagerie Médicale, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Philippe Bertrand
- Service de Radiologie, CHU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours Cedex, France
| | - Juliette Bouffard
- Service de Radiologie et Imagerie Médicale, Pavillon 3 B, Centre Hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre Benite Cedex, France
| | - Jean-Luc Bourrain
- Département pluridisciplinaire de médecine, Service de Dermatologie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Bruno Boyer
- Service de Radiologie, Centre Alexis Vautrin, 6 avenue de Bourgogne, 54 511 Vandoeuvre cedex, France
| | - Marie-France Carette
- Centre d’Allergologie, Hôpital TENON, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Christine Caron-Poitreau
- CHRU Angers, Hôpital Hôtel Dieu, Service de Radiologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Béatrice Cavestri
- Service de Pneumologie du Pr André-Bernard Tonnel, Hôpital Calmette, Boulevard du Professeur Leclerc, 59037 Lille cedex, France
| | - Jean Pierre Cercueil
- Service de Radiologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, BP 77908, 21034 Dijon Cedex, France
| | - Denis-André Charpin
- Service de Pneumologie- Allergologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Evelyne Collet
- Service de Dermatologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, 21034 Dijon Cedex, France
| | - Arielle Crombe-Ternamian
- Service de Radiologie digestive, Pavillon H, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jacques Dalmas
- Service d'Imagerie Médicale, Centre Hospitalier de Martigues, 3 bd des Rayettes, BP 50248, 13698 Martigues Cedex, France
| | - Eric Decoux
- Service de Radiologie, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Marie-France Defrance
- Service de Médecine Interne, Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75674 Paris Cedex 14, France
| | - Yvonne Delaval
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Pascal Demoly
- Service d'Allergologie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, 371 Av Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Claude Depriester
- Service d'Imagerie Médicale, Polyclinique du Bois, 44 avenue Marx Dormoy, 59000 Lille, France
| | | | - Alain Didier
- Service de Pneumologie, CHU de Toulouse, Hôpital Larrey, 24 chemin de Pouvourville, 31059 Toulouse Cedex 9, France
| | - Martine Drouet
- CHRU Angers, Hôpital Hôtel Dieu, Laboratoire d'Allergologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Benoît Dupas
- Service de Radiologie, CHU de Nantes, Hôpital Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes Cedex 01, France
| | | | - Charles Dzviga
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raymond, 42055 Saint Etienne Cedex 2, France
| | - Christine Fabre
- Service de Pneumologie, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30029 Nîmes Cedex 9, France
| | - Gilbert Ferretti
- Service Central de Radiologie et d' Imagerie Médicale, CHU Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Corinne Fourre-Jullian
- Service de Pneumo-allergologie, Centre Hospitalier de Martigues, 3 bd des Rayettes, BP 248, 13698 Martigues Cedex, France
| | - Pascal Girardin
- Service de Dermatologie II, Hôpital Saint-Jacques, 2 Place Saint-Jacques, 25030 Besancon Cedex, France
| | - Jacques Giron
- Service Centrale d'Imagerie médicale, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - Marion Gouitaa
- Service de Pneumologie- Allergologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Nicolas Grenier
- Service de Radiologie B, Groupe Hospitalier Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Lydie Guenard Bilbault
- Service Immuno-Allergologie, Hôpital Central, 29, avenue Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France
| | - Stéphane Guez
- Unité des Maladies Allergiques, Groupe Hospitalier Pellegrin, Bâtiment PQR, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | | | - Jean-François Heautot
- Service de Radiologie, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France
| | - Dominique Herbin
- Service de Pneumologie, Centre hospitalier Louis Pasteur, 46, rue du val de saire, 50102 Cherbourg Cedex, France
| | - Cyrille Hoarau
- Service d'Immunologie Clinique et Néphrologie, CHRU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37 044 Tours Cedex, France
| | - Claude Jacquot
- Département d'Anesthésie Réanimation 1, CHU de Grenoble, Hôpital A.Michallon, BP 127, 38043 Grenoble Cedex 09, France
| | - Christian Julien
- Service d'imagerie médicale, Centre hospitalier Louis Pasteur, 46, rue du val de saire, 50 102 Cherbourg Cedex, France
| | - Laurent Laborie
- Service de Radiologie A, CHRU Jean Minjoz, 22, Bd A. Flemming, 25030 Besancon Cedex, France
| | - Claude Lambert
- Laboratoire Immunologie, Pavillon 5 bis, CHU de Saint-Etienne, Hôpital Bellevue, 42055 Saint Etienne Cedex 2, France
| | - Pascal Larroche
- Service de Radiologie, Hôpital de la Cavale blanche, Boulevard Tanguy Prigent, 29200 BREST Cedex, France
| | - Xavier Leclerc
- Service de Neuroradiologie, CHRU, Hôpital Roger Salengro, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - Laurent Lemaitre
- Plateau Commun d'Imagerie Médicale, Hôpital Claude Huriez, Rue Michel Polonovski, 59037 Lille Cedex, France
| | - Francisque Leynadier
- Centre d’Allergologie, Hôpital TENON, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Agnès Lillo-Le-Louet
- Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cedex 15, France
| | - Jean-Pierre Louvel
- Service de Radiologie, CHU de Rouen, Hôpital de Boisguillaume-147, avenue du Maréchal Juin, 76230, Boisguillaume, France
| | - Nathalie Louvier
- Service Anesthésie Réanimation, Centre Georges Francois Leclerc, 1 rue Professeur Marion, BP 77980, 21079 Dijon Cedex, France
| | - Marie-Madeleine Lucas
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Geneviève Meites
- Service de Radiologie, Hôpital Rangueil, 1, avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France
| | - Nicolas Mennesson
- Service de Radiologie digestive, Pavillon H, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Liliane Metge
- Département d'Imagerie Médicale, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30 029 Nimes Cedex 9, France
| | - Yannick Meunier
- Département d'Anesthésie Réanimation, CHU de Rouen, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen Cedex, France
| | - Laurence Monnier-Cholley
- Service de Radiologie, Hôpital Saint Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Mariano Musacchio
- Service de Radiologie, Hôpitaux civils, Hôpital Pasteur, Neuro Radiologie Pôle 3, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Brigitte Nicolie
- CHRU Angers, Hôpital Hôtel Dieu, Unité fonctionnelle d'allergologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Gisèle Occelli
- Service de Pneumologie, CHU de Nice, Hôpital Pasteur, H.O, 30, avenue de la Voie Romaine, 06100 Nice, France
| | - Hélène Oesterle
- Service de Radiologie, Hôpitaux civils, Hôpital Pasteur, Neuro Radiologie Pôle 3, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Francine Paisant-Thouveny
- CHRU Angers, Hôpital Hôtel Dieu, Service de Radiologie C, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Michel Panuel
- Service de Radiologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Nadine Railhac
- Service de Radiologie, Hl Purpan, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - Frédérique Rety-Jacob
- Service de Radiologie et Imagerie Médicale, Pavillon 3 B, Centre Hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre Benite Cedex, France
| | - Cécile Rochefort-Morel
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Catherine Roy
- Service de Radiologie B, Pavillon Chirurgical A, Hôpital Civil, 1 place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
| | - Philippe Sarlieve
- Service de Radiologie A et C, CHRU Jean Minjoz, 22, Bd A.Flemming, 25030 Besancon Cedex, France
| | - Musa Sesay
- Service de Radiologie, Groupe Hospitalier Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Catherine Sgro
- Service de Pharmacologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, 21034 Dijon Cedex, France
| | - Patrice Taourel
- Service de Radiologie A, CHU de Montpellier, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Patrick Terrier
- Service de Pneumologie, CHU de Rouen, Hôpital Charles Nicolle, 1, rue Germont, 76031 Rouen Cedex, France
| | - Odile Theissen
- Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux civils, Hôpital Pasteur, Pôle 2, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Ingrid Topenot
- Service de Dermatologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jocelyne Valfrey
- Département d'Anesthésie, Hôpital Lyautey, 1 rue des Canonniers, 67100 Strasbourg, France
| | - Francis Veillon
- Service de Radiologie 1, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Marie-Claude Vergnaud
- Service de médecine polyvalente, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Charles Veyret
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raymond, 42055 Saint Etienne Cedex 2, France
| | - Denis Vincent
- Service de Pneumologie – Médecine Interne, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30029 Nimes Cedex 9, France
| | - Benoit Wallaert
- Service de Pneumologie, CHR de Lille, Clinique des Maladies Respiratoires, RCO - Hôpital Calmette, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - François Wessel
- Service de Pneumologie, Hôpital G et R Laënnec, Bd Jacques Monod, 44093 Nantes Cedex 1, France
| | - Marc Zins
- Service de Médecine Interne, Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75674 Paris Cedex 14, France
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Moreno E, Gracia-Bara MT, Mayorga C, Lázaro M, Campanón MV, Dávila I. Hypersensitivity Reactions to Iodinated Contrast Media: Is it a True Allergy? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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