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Zeng W, Tang J, Xu X, Zhang Y, Zeng L, Zhang Y, Liang Z, Xia C, Zhao L, Li Z. Safety of non-ionic contrast media in CT examinations for out-patients: retrospective multicenter analysis of 473,482 patients. Eur Radiol 2024; 34:5570-5577. [PMID: 38457038 DOI: 10.1007/s00330-024-10654-2] [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: 07/31/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China. MATERIALS AND METHODS A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type. RESULTS Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p = 0.035) and autumn (adjusted OR = 1.925; p < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence. CONCLUSION The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol. CLINICAL RELEVANCE STATEMENT In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity. KEY POINTS • The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn.
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Affiliation(s)
- Wen Zeng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xu Xu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lingming Zeng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yiteng Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zejun Liang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lihong Zhao
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
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Dettwiler M, Boehm IB. Drug provocation tests (DPTs) of contrast media: Useful or not useful? - A narrative review. World Allergy Organ J 2024; 17:100946. [PMID: 39252791 PMCID: PMC11382110 DOI: 10.1016/j.waojou.2024.100946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/12/2024] [Accepted: 07/24/2024] [Indexed: 09/11/2024] Open
Abstract
Drug provocation tests (DPTs) are also used in some patients with a history of a contrast medium (CM)-hypersensitivity reaction. Since the use of contrast agents requires special knowledge that is present in radiology but not necessarily in allergology, this overview should close the knowledge gaps. The literature, and the package inserts of the industry dealing with DPTs in contrast hypersensitivity reactions was analyzed and the results presented. Historical analyses revealed that provocation tests were already done in the past, and called pre-testing. Due to disadvantages, this diagnostic tool was abandoned. A few years later, DPT was introduced as an innovative diagnostic procedure. The DPT has the 3 main disadvantages: a missing standardization, patients at risk (such as compromised renal function) are rarely taken into account, and a negative DPT does not exclude a subsequent CM reaction. DPTs (formerly called pre-testing) are a well-known method for diagnosing CM-related hypersensitivity reactions. Since the disadvantages of this diagnosis outweigh the advantages, we propose replacing DPT with routine contrast-enhanced imaging examination in radiology.
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Affiliation(s)
- Manuel Dettwiler
- Department of Internal Medicine, Hospital Zollikerberg, Zurich, Switzerland
| | - Ingrid B Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
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Brockow K. An algorithm for the management of radiocontrast media hypersensitivity, 2024 update. Allergy 2024; 79:2570-2572. [PMID: 38887890 DOI: 10.1111/all.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/16/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Barbaud A, Goncalo M, Mockenhaupt M, Copaescu A, Phillips EJ. Delayed Skin Testing for Systemic Medications: Helpful or Not? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2268-2277. [PMID: 38977212 DOI: 10.1016/j.jaip.2024.06.047] [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: 05/16/2024] [Revised: 06/13/2024] [Accepted: 06/23/2024] [Indexed: 07/10/2024]
Abstract
Cutaneous adverse drug reactions collectively are delayed drug reactions such as morbilliform drug eruption and severe cutaneous adverse reactions (SCARs). Morbilliform drug eruption may wane over time, be the result of drug viral interactions, and be amenable to slow reintroduction or rechallenge, whereas SCARs are HLA class I restricted, T-cell-mediated reactions that demonstrate durable immunity and warrant lifelong avoidance. SCARs such as drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome and toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and generalized bullous fixed drug eruption often occur in the setting of multiple drugs dosed together. Collectively, they lead to significant morbidity, mortality, and drug safety concerns that could severely limit future treatment options. Currently, no single or combination of diagnostic tests for SCARs such as ex vivo or in vitro testing, in vivo (skin) testing, or other adjunctive tests such as HLA typing have 100% negative predictive value. In this "Controversies in Allergy Review" article, we review the current literature on delayed skin testing (patch and delayed prick/intradermal test) and critically assess the evidence base of its utility across different drugs and clinical phenotypes of delayed hypersensitivity reactions.
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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, Département de dermatologie et allergologie, Paris, France
| | - Margarida Goncalo
- Department of Dermatology, University Hospital, Coimbra Local Health Unit, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maja Mockenhaupt
- Dokumentationszentriúm schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ana Copaescu
- The Research Institute of McGill University Health Center, McGill University, Montreal, Canada; Center for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
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Olivieri B, Ghilarducci A, Nalin F, Bonadonna P. Mast cell conditions and drug allergy: when to suspect and how to manage. Curr Opin Allergy Clin Immunol 2024; 24:195-202. [PMID: 38814742 DOI: 10.1097/aci.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE OF REVIEW Patients with mast cell disorders frequently experience symptoms from excessive mediator release like histamine and tryptase, ranging from mild flushing to severe anaphylactic responses. Hypersensitivity reactions (HRs) to drugs are a major cause of anaphylaxis in these patients, who often worry about triggering mast cell degranulation when taking medications. The aim of this review is to explore the complex interactions between mast cell disorders and drug HRs, focusing on the clinical challenges of managing these conditions effectively to enhance understanding and guide safer clinical practices. RECENT FINDINGS Among the drugs most commonly associated with hypersensitivity reactions in patients with mast cell disorders are non-steroidal anti-inflammatory drugs, antibiotics, and perioperative agents. Recent studies have highlighted the role of Mas-related G-protein coupled receptor member X2 (MRGPRX2) - a receptor involved in non-immunoglobulin E mediated mast cell degranulation - in exacerbating HRs. Investigations reveal varied drug tolerance among patients, underscoring the need for individual risk assessments. SUMMARY Tailored diagnostic approaches are crucial for confirming drug allergies and assessing tolerance in patients with mastocytosis, preventing unnecessary medication avoidance and ensuring safety before acute situations arise.
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Affiliation(s)
- Bianca Olivieri
- Allergy Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
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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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Chang JH, Stitzel H, Wehrle C, Tu C, Naples R, Naffouje SA, Matthew Walsh R, Simon R. Contrasting concerns: a retrospective cohort study evaluating intraoperative cholangiogram patients with allergies. HPB (Oxford) 2024:S1365-182X(24)01778-7. [PMID: 39004534 DOI: 10.1016/j.hpb.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/12/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Jenny H Chang
- Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH, USA.
| | - Henry Stitzel
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chase Wehrle
- Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH, USA
| | - Chao Tu
- Cleveland Clinic, Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA
| | - Robert Naples
- Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH, USA
| | - Samer A Naffouje
- Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH, USA
| | - R Matthew Walsh
- Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH, USA
| | - Robert Simon
- Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH, USA
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Vega F, van de Ven AAJM, van der Molen AJ. Cross-reactivity in hypersensitivity reactions to contrast agents: new classification and guide for clinical practice. Eur Radiol 2024:10.1007/s00330-024-10872-8. [PMID: 38937294 DOI: 10.1007/s00330-024-10872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Francisco Vega
- Department of Allergy, Hospital Universitario de la Princesa, Madrid, Spain
| | - Annick A J M van de Ven
- Department of Internal Medicine, Division of Allergology, University Medical Center Groningen, Groningen, The Netherlands
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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9
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Samaran Q, Clark E, Chiriac AM, Bourrain JL, Dereure O, Bessis D, Raison-Peyron N. An atypical case of prolonged systemic allergic dermatitis to iodinated contrast media. Contact Dermatitis 2024. [PMID: 38936956 DOI: 10.1111/cod.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Quentin Samaran
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Evangéline Clark
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
- IDESP, Université de Montpellier - INSERM, Montpellier, France
| | - Anca Mirela Chiriac
- IDESP, Université de Montpellier - INSERM, Montpellier, France
- Department of Pulmonology, Division of Allergy, Montpellier University Hospital, Montpellier, France
| | - Jean-Luc Bourrain
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
- Department of Pulmonology, Division of Allergy, Montpellier University Hospital, Montpellier, France
| | - Olivier Dereure
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Didier Bessis
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Nadia Raison-Peyron
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
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Griffith Brookles C, Bianco M, Pizzimenti S, Gobello G, Biolè C, Destefanis P, Cerrato E, Chinaglia A. Management of acute coronary syndromes requiring coronary angiography in patients with drug reaction with eosinophilia and systemic symptoms syndrome induced by iodinated contrast media: two case reports and narrative review. Eur Heart J Case Rep 2024; 8:ytae259. [PMID: 38835993 PMCID: PMC11148818 DOI: 10.1093/ehjcr/ytae259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
Background Hypersensitivity reactions to iodinated contrast media (ICM) are frequently encountered in clinical practice. Severe manifestations, despite being infrequent, can be life-threatening and represent an issue when re-administration of ICM is required. Clear recommendations on prevention and management of relapses are still lacking. Case summary We present the cases of two patients presenting with acute coronary syndrome requiring urgent coronary angiography, with an anamnesis of ICM-induced drug reaction with eosinophilia and systemic symptoms syndrome. Both patients safely underwent a coronary angiography with the use of a different ICM (iobitridol) to the one linked to hypersensitivity manifestations, after premedication with corticosteroids and H1 antagonists. Discussion Our experience highlights that in clinical situations in which the use of ICM is urgently needed, premedication with corticosteroids and H1 antagonists together with the choice of an alternative contrast agent (when the culprit is known) represents an effective strategy to perform a potentially life-saving procedure while avoiding serious systemic allergic reactions.
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Affiliation(s)
- Carola Griffith Brookles
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Matteo Bianco
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Stefano Pizzimenti
- Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Giulia Gobello
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carloalberto Biolè
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Enrico Cerrato
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Alessandra Chinaglia
- Cardiology Division, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Zhang Y, Yuan D, Qi K, Zhang M, Zhang W, Wei N, Li L, Lv P, Gao J, Liu J. Feasibility Analysis of Individualized Low Flow Rate Abdominal Contrast-Enhanced Computed Tomography in Chemotherapy Patients: Dual-Source Computed Tomography With Low Tube Voltage. J Comput Assist Tomogr 2024:00004728-990000000-00319. [PMID: 38693081 DOI: 10.1097/rct.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of the study is to investigate the feasibility of using dual-source computed tomography (CT) combined with low flow rate and low tube voltage for postchemotherapy image assessment in cancer patients. METHODS Ninety patients undergoing contrast-enhanced CT scans of the upper abdomen were prospectively enrolled and randomly assigned to groups A, B, and C (n = 30 each). In group A, patients underwent scans at 120 kVp with 448 mgI/kg. Patients in group B underwent scans at 100 kVp with 336 mgI/kg. Patient in group C underwent scans at 70 kVp with of 224 mgI/kg. Quantitative measurements including the CT number, standard deviation of CT number, signal-to-noise ratio, contrast-to-noise ratio, subjective reader scores, and the volume and flow rate of contrast agent were evaluated for each group. RESULTS There was no statistically significant difference in the subjective image scores within the three groups except for the kidney (all P > 0.05). Group C showed significantly higher CT values, lower noise levels, and higher signal-to-noise ratio and contrast-to-noise ratio values in the majority of the regions of interest compared to the other groups (P < 0.05). In group C, the contrast agent dose was decreased by 46% compared to group A (79.48 ± 12.24 vs 42.7 ± 8.6, P < 0.01), and the contrast agent injection rate was reduced by 22% (2.7 ± 0.41 vs 2.1 ± 0.4, P < 0.01). CONCLUSIONS The use of 70 kVp tube voltage combined with low iodine flow rates prove to be a more effective approach in solving the challenge of compromised blood vessels in postchemotherapy tumor patients, without reducing image quality and diagnostic confidence.
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Affiliation(s)
- Yicun Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Dian Yuan
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Ke Qi
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Mengyuan Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Weiting Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Nannan Wei
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | | | - Peijie Lv
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Jianbo Gao
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Jie Liu
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
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Mija LA, Désy D, Filion CA, Picard M. Cutaneous Leukocytoclastic Vasculitis Induced by the Iodinated Contrast Media Iohexol With Cross-Reactivity to Iodixanol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1346-1347. [PMID: 38551524 DOI: 10.1016/j.jaip.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/12/2024]
Affiliation(s)
| | - Delphine Désy
- Hôpital Maisonneuve-Rosemont, Department of Pathology and Cellular Biology, Université de Montreal, Montreal, Quebec, Canada
| | - Charles Alexandre Filion
- Hôpital Maisonneuve-Rosemont, Department of Medicine, Division of Clinical Immunology and Allergy, Université de Montreal, Montreal, Canada
| | - Matthieu Picard
- Hôpital Maisonneuve-Rosemont, Department of Medicine, Division of Clinical Immunology and Allergy, Université de Montreal, Montreal, Canada.
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Soria A, Bernier C, Milpied B, Assier H, Castelain F, Amsler E, Barbaud A. Administration of an alternative iodinated contrast media in confirmed severe delayed hypersensitivity reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1362-1367.e1. [PMID: 38490579 DOI: 10.1016/j.jaip.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Angèle Soria
- Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France.
| | - Claire Bernier
- Service de Dermatologie et Plateforme Transversale d'Allergologie, Hôpital Hôtel Dieu, Nantes, France
| | | | - Haudrey Assier
- Service de Dermatologie, Hôpital Henri Mondor, Créteil, France
| | | | - Emmanuelle Amsler
- Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Annick Barbaud
- Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Paris, France
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14
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Rašiová M, Schlager O, Heiss C, Brodmann M, Olinic DM, Boc V, Buso G, Belch J, Mazzolai L, Madaric J. Adverse reactions after intravascular iodinated contrast media administration and their management. VASA 2024; 53:193-203. [PMID: 38651340 DOI: 10.1024/0301-1526/a001122] [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] [Indexed: 04/25/2024]
Abstract
Endovascular interventions and diagnostic examinations using iodinated contrast media (ICM) are standard of care in current vascular medicine. Although ICM use is generally considered safe, it may be associated with adverse reactions, vary from minor disturbances to rare, but severe life-threatening complications. This position paper of European Society of Vascular Medicine integrates current knowledge and summarizes the key information related to the use of intravascular ICM, serving as recommendation on prevention and management of acute, late, and very late adverse reactions. It should help the health professionals in all fields of vascular medicine to make decisions in daily practice for safe use of contrast media.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, Faculty of Medicine, University of Pavol Jozef Šafárik, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Vascular Department, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, United Kingdom
| | | | - Dan Mircea Olinic
- Department of Interventional Cardiology, Medical Clinic No. 1, Emergency County Hospital, Cluj-Napoca, Romania
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - Jill Belch
- Division of Molecular and Clinical Medicine, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madaric
- Department of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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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] [Grants] [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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16
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Lemmenmeier S, Boehm IB. Injection of iodinated contrast media in lactating women: Shall we continue or stop breastfeeding? Eur J Radiol 2024; 175:111464. [PMID: 38636412 DOI: 10.1016/j.ejrad.2024.111464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Sina Lemmenmeier
- Department of Anaesthesiology, Spital of Buelach, Buelach, Switzerland
| | - Ingrid B Boehm
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
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17
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Zhang D, Yang X, Yang Z, Sun W, Chen S, Xu L. Detection of iodixanol-induced allergic reaction signals in Chinese inpatients: a multi-center retrospective database study using prescription sequence symmetry analysis. Front Pharmacol 2024; 15:1298021. [PMID: 38601462 PMCID: PMC11004274 DOI: 10.3389/fphar.2024.1298021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Objective This study aimed to explore the signal detection method for allergic reactions induced by inpatient iodixanol injection. Methods A database of 3,719,217 hospitalized patients from 20 large Chinese general hospitals was processed and analyzed using the prescription sequence symmetry analysis (PSSA) method. Results 126,680 inpatients who used iodixanol and were concurrently treated with anti-allergic drugs were analyzed. In the medical records of these patients, only 32 had documented iodixanol allergies. Statistical analysis identified 22 drugs in 4 categories-calcium preparations, adrenergic/dopaminergic agents, glucocorticoids, and antihistamines-as marker drugs. With time intervals of 3, 7, and 28 days, the adjusted sequence ratios (aSRs) for all anti-allergics and the 4 categories were greater than 1. The 7-day aSRs were 2.12 (95% CI: 2.08-2.15), 1.70 (95% CI: 1.68-1.73), 3.85 (95% confidence interval [CI]: 3.75-2.30), 2.30 (95% CI: 2.26-2.35), and 1.95 (95% CI: 1.89-2.02), respectively. The proportions of adverse drug events indicated by each signal were as follows: all anti-allergics (2.92%-3%), calcium gluconate (0.19%-0.52%), adrenergic/dopaminergic agents (2.20%-3.37%), glucocorticoids (3.13%-3.76%), and antihistamines (1.05%-1.32%). Conclusion This first multi-center Chinese inpatient database study detected iodixanol-induced allergy signals, revealing that reactions may be much higher than those in collected spontaneous reports. Iodixanol risk exposure was closer to actual pharmaceutical care findings. PSSA application with ≤7-day intervals appears better suited for monitoring late allergic reaction signals with these drugs.
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Affiliation(s)
- Dandan Zhang
- Department of Pharmacy, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xinchen Yang
- Electric Engineering and Automation, East China University of Science and Technology, Shanghai, China
| | - Zhangwei Yang
- Medical Department, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Sun
- Medical Department, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shunjie Chen
- Medical Department, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingxiao Xu
- Health Statistics Teaching and Research Section, Tongji University, Shanghai, China
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18
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Mayorga C, Çelik GE, Pascal M, Hoffmann HJ, Eberlein B, Torres MJ, Brockow K, Garvey LH, Barbaud A, Madrigal-Burgaleta R, Caubet JC, Ebo DG. Flow-based basophil activation test in immediate drug hypersensitivity. An EAACI task force position paper. Allergy 2024; 79:580-600. [PMID: 38084472 DOI: 10.1111/all.15957] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 12/22/2023]
Abstract
Diagnosing immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge and there is an urgent need for safe and reliable tests. Evidence has emerged that the basophil activation test (BAT), an in vitro assay that mirrors the in vivo response, can be a complementary test for many drugs. In this position paper, members of Task Force (TF) "Basophil activation test in the evaluation of Drug Hypersensitivity Reactions" from the European Academy of Allergy and Clinical Immunology (EAACI) present the data from a survey about the use and utility of BAT in IDHRs in Europe. The survey results indicate that there is a great interest for using BAT especially for diagnosing IDHRs. However, there are still main needs, mainly in the standardization of the protocols. Subsequently consensus-based recommendations were formulated for: (i) Technical aspects of BAT in IDHRs including type of sample, management of drugs, flow cytometry protocols, interpretation of the results; and (ii) Drug-specific aspects that should be taken into account when performing BAT in relation to betalactams, neuromuscular blocking agents, fluoroquinolones, chlorhexidine, opioids, radio contrast media, chemotherapeutics, biological agents, nonsteroidal anti-inflammatory drugs, COVID vaccine, and excipients. Moreover, aspects in the evaluation of pediatric population have also been considered. All this indicates that BAT offers the clinician and laboratory a complementary tool for a safe diagnostic for IDHRs, although its place in the diagnostic algorithm depends on the drug class and patient population (phenotype, geography, and age). The standardization of BAT is important for generalizing this method beyond the individual laboratory.
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Affiliation(s)
- C Mayorga
- Allergy Unit, Hospital Regional Universitario de Málaga and Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- RETICS Asma reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
| | - G E Çelik
- Department of chest disease, Division of Allergy & Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - M Pascal
- RETICS Asma reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - H J Hoffmann
- Department of Clinical Medicine and Department of Clinical Immunology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - B Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - M J Torres
- Allergy Unit, Hospital Regional Universitario de Málaga and Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- RETICS Asma reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- Medicine Department, Malaga University, Málaga, Spain
| | - K Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - L H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen and Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - A Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - R Madrigal-Burgaleta
- Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - J C Caubet
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - D G Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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19
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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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20
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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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Ringwald M, Moi L, Wetzel A, Comte D, Muller YD, Ribi C. Risk factors for allergy documentation in electronic health record: A retrospective study in a tertiary health center in Switzerland. Allergol Int 2024; 73:143-150. [PMID: 37455165 DOI: 10.1016/j.alit.2023.06.006] [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: 03/02/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Most hospitals use electronic health records (EHR) to warn health care professionals of drug hypersensitivity (DH) and other allergies. Indiscriminate recording of patient self-reported allergies may bloat the alert system, leading to unjustified avoidances and increases in health costs. The aim of our study was to analyze hypersensitivities documented in EHR of patients at Lausanne University Hospital (CHUV). METHODS We conducted a retrospective study on patients admitted at least 24 h to CHUV between 2011 and 2021. After ethical clearance, we obtained anonymized data. Because culprit allergen could be either manually recorded or selected through a list, data was harmonized using a reference allergy database before undergoing statistical analysis. RESULTS Of 192,444 patients, 16% had at least one allergy referenced. DH constituted 60% of all allergy alerts, mainly beta-lactam antibiotics (BLA) (30%), NSAID (11%) and iodinated contrast media (ICM) (7%). Median age at first hospitalization and hospitalization length were higher in the allergy group. Female to male ratio was 2:1 in the allergic group. Reactions were limited to the skin in half of patients, and consistent with anaphylaxis in 6%. In those deemed allergic to BLA, culprit drug was specified in 19%, 'allergy to penicillin' otherwise. It was impossible to distinguish DH based on history alone or resulting from specialized work-up. CONCLUSIONS Older age, longer hospital stays, and female sex increase the odds of in-patient allergy documentation. Regarding DH, BLA were referenced in 4% of inpatient records. Specific delabeling programs should be implemented to increase data reliability and patient safety.
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Affiliation(s)
- Maxime Ringwald
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Laura Moi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Wetzel
- Data Science & Research, Direction of Informatics Systems, Department of Infrastructures, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Denis Comte
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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22
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Lombardo P, Nairz K, Boehm I. Why mild contrast medium-induced reactions are sometimes over-treated and moderate/severe reactions of internal organs are undertreated: a summary based on RadioComics. Insights Imaging 2023; 14:196. [PMID: 37980636 PMCID: PMC10657911 DOI: 10.1186/s13244-023-01554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Paolo Lombardo
- Department of Diagnostic, Interventional, and Pediatric Radiology, University of Bern, Academic Hospital (Inselspital), Bern, Switzerland
| | - Knud Nairz
- Department of Diagnostic, Interventional, and Pediatric Radiology, University of Bern, Academic Hospital (Inselspital), Bern, Switzerland
| | - Ingrid Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, University of Bern, Academic Hospital (Inselspital), Bern, Switzerland.
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23
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Bianchi L, Hansel K, Biondi F, Caroppo ES, Galeotti T, Casciola G, Tramontana M, Marietti R, Napolitano M, Patruno C, Stingeni L. Delayed hypersensitivity reactions to iodinated contrast media: A diagnostic approach by skin tests. Contact Dermatitis 2023; 89:352-358. [PMID: 37394777 DOI: 10.1111/cod.14372] [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: 05/25/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Adverse drug reactions to iodinated contrast media (ICM) have risen due to their increasing use in x-ray-based imaging modalities. Delayed hypersensitivity reactions are mainly caused by nonionic monomeric compounds and represent an issue impacting the diagnostic-therapeutic pathways of cancer, cardiology and surgery patients. OBJECTIVES To prospectively evaluate the usefulness of skin tests in delayed hypersensitivity reactions to ICM and to evaluate the tolerability of iobitridol, a monomeric nonionic low osmolality compound, as a possible safe alternative. METHODS Patients with delayed hypersensitivity reactions to ICM referred to us from 2020 to 2022 were prospectively enrolled in the study. All patients underwent patch test and, if negative, intradermal test with the culprit ICM and iobitridol as alternative. RESULTS A total of 37 patients (females 24, 64.9%) were enrolled in the study. Iodixanol and iomeprol were the most frequently involved ICM (48.5% and 35.2%, respectively); 62.2% of patients presented maculopapular eruption, while 37.8% reported delayed urticaria-like rash. Skin tests resulted positive to the culprit ICM in 19 patients (51.4%), 16 to patch test and 3 to intradermal test. Skin tests with iobitridol, tested as alternative, resulted positive in 3/19 patients (15.8%). All 16 patients with negative results to iobitridol were administered this ICM and tolerated it. CONCLUSIONS In at least half of patients, delayed-type hypersensitivity was demonstrated by skin tests, particularly by patch test. This diagnostic approach resulted simple, cost-effective and safe, not only to confirm the culprit ICM but also to identify iobitridol as feasible alternative.
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Affiliation(s)
- Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Sofia Caroppo
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Tommaso Galeotti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Casciola
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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24
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Jia Y, Szewczyk-Bieda M, Greenhalgh R, Drinkwater K. Preventing post-contrast acute kidney injury and hypersensitivity reactions: UK national audit. Clin Radiol 2023; 78:e898-e907. [PMID: 37612224 DOI: 10.1016/j.crad.2023.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
AIM To audit UK radiology departmental protocols related to the prevention of Iodine-based contrast media (ICM) adverse drug reactions (ADRs) and to assess their compliance with the Royal College of Radiologists (RCR) endorsed Royal Australian and New Zealand College of Radiologists' 2018 Iodinated Contrast Guidelines. MATERIALS AND METHODS Questionnaires were sent to all UK acute National Health Service (NHS) providers treating adult patients with an audit lead registered with the RCR (162 providers encompassing 211 hospital radiology departments). The questionnaire included three main sections: renal function screening, renal protection regimens, and hypersensitivity reactions prevention and follow-up. Data collection was conducted between April and July 2022. RESULTS Sixty-one per cent (129/211) of departments responded, representing 67% of eligible providers. An independent imaging services provider supplied one additional set of data (n=130 overall). Of the responding departments, for post-contrast acute kidney injury (PC-AKI), 41% and 56% had the recommended risk assessment for inpatients and outpatients, respectively. Renal function testing was often over-utilised, and their results were applied improperly. Sixty-eight per cent of departments used the advised threshold for considering renal protection. For hypersensitivity reactions, 9% of departments had the correct risk assessment. Thirty-six per cent of departments had the correct risk mitigation protocol for identified high-risk patients. The documentation and follow-up for hypersensitivity reactions were similarly inadequate. CONCLUSION Local protocols on preventing ICM ADRs were largely non-compliant with RCR guidelines. Departments need to update their protocols in line with current evidence to avoid iatrogenic morbidity or unnecessary tests and over-precaution.
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Affiliation(s)
- Y Jia
- Department of Medicine, Imperial College London, London, UK.
| | - M Szewczyk-Bieda
- Department of Clinical Radiology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - R Greenhalgh
- Department of Radiology, London North West University Healthcare NHS Trust, London, UK
| | - K Drinkwater
- Directorate of Education and Professional Practice, The Royal College of Radiologists, London, UK
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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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Kim S, Jeon KN, Jung JW, Park HK, Lee W, Lee J, Kang HR. Substitution with Low-Osmolar Iodinated Contrast Agent to Minimize Recurrent Immediate Hypersensitivity Reaction. Radiology 2023; 309:e222467. [PMID: 37906013 DOI: 10.1148/radiol.222467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background The recurrence of hypersensitivity reaction (HSR) to low-osmolar iodinated contrast media (LOCM) remains challenging despite premedication and substitution of the LOCM. Purpose To determine the optimal practical preventive strategy for LOCM substitution in patients with a history of prior immediate HSR to LOCM. Materials and Methods In a retrospective study, patients with an immediate HSR to LOCM before February 2020 and who underwent subsequent exposure to LOCM until March 2021 were enrolled in five tertiary referral hospitals in South Korea. The association of recurrence of an HSR after subsequent LOCM exposures was assessed using multivariate general estimating equation analysis according to age, sex, the severity of the index HSR, premedication, and substituting LOCM based on common carbamoyl side chains, including the N-(2,3-dihydroxypropyl)-carbamoyl and N-(2,3-dihydroxypropyl)-N-methyl-carbamoyl moieties. Results The evaluation included 3800 subsequent LOCM exposures in 1066 patients (mean age, 56.2 years ± 13.5 [SD]; 567 [53%] female and 499 [47%] male patients). The general estimating equation analysis, using 1:1 propensity score matched data for age, sex, HSR severity, and LOCM selection, showed that premedication with corticosteroids significantly reduced recurrent HSR (odds ratio [OR], 0.72; 95% CI: 0.52, 1.00; P = .049). The change to another LOCM with a common side chain had a similar recurrence rate as using the same LOCM (OR, 0.98; 95% CI: 0.64, 1.50; P = .93), whereas the use of a different LOCM without a common side chain significantly lowered HSR recurrence (OR, 0.51; 95% CI: 0.37, 0.69; P < .001) in multivariate general estimating equation analysis. Substitution of an LOCM without a common side chain was effective regardless of the index HSR severity but was more pronounced in moderate-to-severe reactions (OR, 0.30; 95% CI: 0.16, 0.55; P < .001). Conclusion For patients with a previous immediate HSR of any severity to LOCM, alternative LOCM without a common carbamoyl side chain reduced recurrent HSR during subsequent exposures. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by McDonald in this issue.
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Affiliation(s)
- Sujeong Kim
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
| | - Kyung Nyeo Jeon
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
| | - Jae-Woo Jung
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
| | - Han-Ki Park
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
| | - Whal Lee
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
| | - Jongmin Lee
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
| | - Hye-Ryun Kang
- From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.)
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27
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McDonald JS. Selecting an Alternative Contrast Agent to Prevent Repeat Allergic-like Reactions. Radiology 2023; 309:e231979. [PMID: 37906007 DOI: 10.1148/radiol.231979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Jennifer S McDonald
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Chatani R, Kondo S, Kamimura T, Suzuki S, Komatsubara E, Hayashi S, Hashiguchi M, Kizaki H, Imai S, Hori S. Exploring Factors Affecting the Occurrence of Hypersensitivity Reactions Induced by Nonionic Iodine Contrast Media. J Clin Pharmacol 2023; 63:1002-1008. [PMID: 37114401 DOI: 10.1002/jcph.2256] [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: 12/05/2022] [Accepted: 04/23/2023] [Indexed: 04/29/2023]
Abstract
Hypersensitivity reactions induced by nonionic iodine contrast media sometimes occur and can be life threatening. However, independent factors affecting their occurrence remain to be fully established. Therefore, the purpose of this study was to clarify independent factors affecting the occurrence of hypersensitivity reactions induced by nonionic iodine contrast media. Patients who received nonionic iodine contrast media at Keiyu Hospital from April 2014 to December 2019 were included. The adjusted odds ratio (OR) and 95% confidence interval (CI) for factors affecting hypersensitivity reactions induced by contrast media were calculated by logistic regression analysis. The multiple imputation method was used to impute missing data. Hypersensitivity reactions occurred in 0.72% (163 cases) of 22,695 cases enrolled in this study. In univariate analysis, 10 variables met the criteria of P < .05 and proportion of missing data <50%. In multivariate analysis, age (OR, 0.98; 95% CI, 0.97-0.99), outpatient status (OR, 2.08; 95% CI, 1.20-3.60), contrast medium iodine content (OR, 1.02; 95% CI, 1.01-1.04), history of drug allergy (OR, 2.41; 95% CI, 1.50-3.88), and asthma (OR, 17.4; 95% CI, 7.53-40.1) were identified as independent factors affecting contrast media-induced hypersensitivity reactions. Among these factors, history of drug allergy and asthma appear to be clinically relevant and reliable due to their high OR and plausible biological mechanisms, but the other three factors require further validation.
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Affiliation(s)
| | - Sakura Kondo
- Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Tadamasa Kamimura
- Department of Pharmacy, Kanagawa Prefectural Keiyukai Keiyu Hospital, Yokohama, Kanagawa, Japan
| | - Shinya Suzuki
- Department of Pharmacy, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Eriko Komatsubara
- Department of Pharmacy, Kanagawa Prefectural Keiyukai Keiyu Hospital, Yokohama, Kanagawa, Japan
| | - Seiichi Hayashi
- Department of Pharmacy, Kanagawa Prefectural Keiyukai Keiyu Hospital, Yokohama, Kanagawa, Japan
| | | | - Hayato Kizaki
- Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Shungo Imai
- Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Satoko Hori
- Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
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Fan M, Zheng X, Zhu S. Research progress on desensitization of hypersensitivity reaction to iodinated contrast media. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:526-530. [PMID: 37643986 PMCID: PMC10641507 DOI: 10.3724/zdxbyxb-2023-0220] [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: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
Desensitization therapy for iodinated contrast media (ICM) aims to induce drug tolerance in patients with a history of severe allergic reactions to ICM in a short time. Currently, there is no widely accepted consensus on inducing desensitization to avoid severe allergic responses to ICM. The clinically successful cases have shown that prophylactic use of antihistamines and glucocorticoids can increase the desensitization effect; repeatedly desensitizing and gradually increasing the dose can be conducive to establishing better tolerance to ICM. Most desensitization effects, including stress resistance, can endure 24-48 h. The mechanisms of desensitization therapy remain unclear, the initial dose, administration interval and dose gradient are largely based on clinical experiences and the reaction of patients. This article reviews the current research progress on ICM-related allergies, desensitization methods and related mechanisms, as well as the benefits and hazards of desensitization, to provide a reference for desensitization treatment of hypersensitivity to ICM .
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Affiliation(s)
- Miao Fan
- Department of Pharmacy, the First Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China.
| | - Xiaomeng Zheng
- Department of Pharmacy, the First Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
| | - Suyan Zhu
- Department of Pharmacy, the First Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China.
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Rodríguez-Pérez R, de las Vecillas L, Cabañas R, Bellón T. Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions. Int J Mol Sci 2023; 24:12577. [PMID: 37628756 PMCID: PMC10454098 DOI: 10.3390/ijms241612577] [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: 06/06/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Drug hypersensitivity reactions are a serious concern in clinical practice because they can be severe and result in lifelong sequelae. An accurate diagnosis and identification of the culprit drug is essential to prevent future reactions as well as for the identification of safe treatment alternatives. Nonetheless, the diagnosis can be challenging. In vivo and in vitro tests can be helpful, although none are conclusive; therefore, the tests are not usually performed in isolation but as part of a diagnostic algorithm. In addition, some in vitro tests are only available in research laboratories, and standardization has not been fully accomplished. Collaborating research is needed to improve drug hypersensitivity reaction diagnosis. In this review, we update the current available in vivo and in vitro tools with their pros and cons and propose an algorithm to integrate them into clinical practice.
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Affiliation(s)
- Rosa Rodríguez-Pérez
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
| | - Leticia de las Vecillas
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
- Allergy Department, La Paz University Hospital, Paseo Castellana 261, 28046 Madrid, Spain
- PIELenRed Consortium, 28046 Madrid, Spain
| | - Rosario Cabañas
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
- Allergy Department, La Paz University Hospital, Paseo Castellana 261, 28046 Madrid, Spain
- PIELenRed Consortium, 28046 Madrid, Spain
- Center for Biomedical Research Network on Rare Diseases (CIBERER U754), 28046 Madrid, Spain
| | - Teresa Bellón
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
- PIELenRed Consortium, 28046 Madrid, Spain
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Sáenz de Santa María R, Labella M, Bogas G, Doña I, Torres MJ. Hypersensitivity to gadolinium-based contrast. Curr Opin Allergy Clin Immunol 2023; 23:300-306. [PMID: 37357781 DOI: 10.1097/aci.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The use of contrast media is increasing in recent decades. Although gadolinium-based contrast agents (GBCAs) are generally well tolerated, adverse reactions, including hypersensitivity reactions (HSRs), although infrequent, may occur. It is important to perform a thorough allergological evaluation in patients with suspected GBCA-HSRs to avoid potentially serious reactions in subsequent exposures. RECENT FINDINGS Data on GBCA-HSRs are scarce. Most published articles dealing with skin tests and drug provocation tests (DPTs) with GBCAs are case series and small cohorts. Controversies exist about the role of premedication for preventing HSRs on subsequent exposures. Selection of well tolerated alternatives is based on potential cross-reactivity among GBCAs; however, the extent of cross-reactivity among them remains unclear. SUMMARY As premedication is not useful because breakthrough reactions are frequent in patients with GBCA-HSRs in subsequent exposures, an allergological evaluation is required. Available data suggest a high negative predictive value of skin tests, being crucial for guiding the selection of an alternative GBCA. However, DPTs are still necessary to confirm or exclude the diagnosis or find alternative GBCAs. Cross-reactivity is high among GBCAs belonging from the same group, mainly among macrocyclic compounds, so this must be taken into account for selecting alternatives.
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Affiliation(s)
- Rocío Sáenz de Santa María
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Marina Labella
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Gádor Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Inmaculada Doña
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - María José Torres
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
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Sodagari F, Davenport MS, Asch D, Cavallo JJ, Cohan RH, Ellis JH, Pahade JK. A Survey of Practicing Radiologists on the Use of Premedication Before Intravenous Iodinated Contrast Medium Administration. J Am Coll Radiol 2023:S1546-1440(23)00532-X. [PMID: 37516161 DOI: 10.1016/j.jacr.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine whether updated guidance by the ACR in 2017 advocating use of intravenous (IV) premedication in emergency department (ED) patients and inpatients with reported iodinated contrast allergy was associated with a change in clinical practice. METHODS An anonymous survey was distributed via e-mail in October 2020 to practicing radiologist members of the ACR interrogating use of corticosteroid premedication for two clinical vignettes: an indicated routine (perform within 24 hours) inpatient contrast-enhanced CT (CE-CT) and an indicated urgent (perform within 6 hours) ED CE-CT. In both scenarios, the patient had a prior moderate hypersensitivity reaction to iodinated contrast media. Clinical management was evaluated. Data were compared to historical controls from 2009. RESULTS The response rate was 11% (724 of 6,616). For the inpatient scenario, 72% (518 of 724) would use corticosteroid premedication with CE-CT, and 28% (200 of 724) would perform noncontrast CT. For the ED scenario, 67% (487 of 724) would use corticosteroid premedication with CE-CT, and 30% (217 of 724) would perform noncontrast CT. Oral premedication (85%, 439 of 518) was preferred for routine inpatients, and rapid IV premedication (89%, 433 of 487) was preferred for urgent ED patients. Of those who provided rapid IV dosing data in the ED, two doses of corticosteroids were used by 53% (216 of 410) and one dose was used by 45% (185 of 410), with academic radiologists more likely than private or hybrid practice radiologists to administer two doses (74% [74 of 100] versus 48% [151 of 312], P < .001, odds ratio, 3.03; 95% confidence interval, 1.84-5.00). Rapid IV premedication was more commonly used in 2020 than in 2009 (60% [433 of 724] versus 29% [20 of 69], P < .001, odds ratio, 3.65; 95% confidence interval, 2.12-6.26). Antihistamine use was common in both inpatient (93%, 480 of 518) and ED settings (92%, 447 of 487). Only 32% (229 of 721) of radiologists practiced in accordance with ACR guidelines, suggesting no need for routine premedication before CE-CT in patients with prior severe hypersensitivity reaction to gadolinium-based contrast media. Nonetheless, most (93%, 670 of 724) said the ACR Manual on Contrast Media was a major determinant of their practice. CONCLUSIONS Use of rapid IV premedication in urgent settings has increased since 2009, following updated ACR guidelines, but there is disagreement over whether one or two corticosteroid doses is required. Despite reported high reliance on ACR guidelines, deviations from those guidelines remain common. In general, when ACR guidelines were not followed, it was in a risk-averse direction.
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Affiliation(s)
- Faezeh Sodagari
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Chair, ACR RFS Women and Diversity Advisory Group; Past-Past President, RFS of Radiological Society of Connecticut. https://twitter.com/fsodagari
| | - Mathew S Davenport
- Michigan Medicine, Ann Arbor, Michigan; Service Chief and Vice Chair in Department of Radiology at Michigan Medicine, Vice Chair of the Commission on Quality and Safety for ACR, Board of Directors for Society of Advanced Body Imaging. https://twitter.com/MattDavenportMD
| | - Daniella Asch
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Associate Medical Director for Quality & Safety, Yale Radiology; Member, ACR Committee on Drugs and Contrast Media
| | - Joseph J Cavallo
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Medical Director, Emergency Radiology; Assistant Director, Informatics; Member, ACR Committee on Drugs and Contrast Media. https://twitter.com/jcavallo972
| | - Richard H Cohan
- Michigan Medicine, Department of Radiology, University of Michigan Hospital, Ann Arbor, Michigan. https://twitter.com/Rich_Cohan
| | - James H Ellis
- Michigan Medicine, Department of Radiology, University Hospital, Ann Arbor, Michigan; Member, ACR Committee on Drugs and Contrast Media
| | - Jay K Pahade
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Vice Chair of Quality & Safety, Yale Radiology; Member, ACR Committee on Drugs and Contrast Media.
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Hammond C. Revisiting the Definition of Anaphylaxis. Curr Allergy Asthma Rep 2023; 23:249-254. [PMID: 37171671 DOI: 10.1007/s11882-023-01077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE OF REVIEW Anaphylaxis is a common phenomenon that has been studied for many decades. Despite this, there is still disagreement among organizations regarding the precise definition for anaphylaxis. This article discusses the difference between the proposed definitions of anaphylaxis. Furthermore, the most up-to-date literature on specific subtypes of anaphylaxis is reviewed, and implications for clinical practice are discussed. RECENT FINDINGS Recent literature on various subtypes of anaphylaxis has been conducted. This has helped clarify guidelines for conditions such as allergy to radiocontrast media, idiopathic anaphylaxis, and food-dependent exercise-induced anaphylaxis. Recent literature has also studied available biomarkers for anaphylaxis and the cost-effectiveness of current standard-of-care prescription of epinephrine autoinjectors. Anaphylaxis is an increasingly more frequent phenomenon and remains a hot topic in current research. Much progress has been made in clarifying the definition of anaphylaxis and differentiating between subtypes, but more research is needed to identify a readily available biomarker for anaphylaxis and identify the standard of care for various subtypes of anaphylaxis.
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Affiliation(s)
- Catherine Hammond
- Department of Pediatrics, Allergy/Immunology, Faculty Office Building, University of Tennessee Health Science Center, 49 North Dunlap, Room #296, 38103, Memphis, TN, USA.
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Koeppel DR, Boehm IB. Shortage of iodinated contrast media: Status and possible chances - A systematic review. Eur J Radiol 2023; 164:110853. [PMID: 37156181 PMCID: PMC10155429 DOI: 10.1016/j.ejrad.2023.110853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Covid-19 related lockdowns have resulted in a shortage of iodinated contrast media (ICM) in 2022. Health care providers have reacted with implementing conservation strategies to stay operational without compromising patient care. Although articles describing the implemented Interventions have been published, possible chances of the shortage have not yet been mentioned in the literature. METHODS We conducted a literature search in PubMed and Google Scholar, and analysed the background, interventions, and possible benefits of low-dose ICM regimens. RESULTS We included 22 articles dealing with "ICM shortage" for the analysis. The delivery bottlenecks in the USA and Australia led to two different countermeasures, 1. reduction of the number of contrast-enhanced image-guided examinations and 2. reduction of the (single) ICM dose. Interventions from both groups have resulted in significant reduction of ICM usage; however, group 1 has contributed more to overall ICM reduction. As benefit of the ICM reduction, we revealed an increased safety for patients at risk (e.g. hypersensitivity reactions, contrast-induced acute kidney injury, thyroid toxic effects). CONCLUSION The ICM shortage of 2022 has forced health care providers to implement conservation strategies to stay operational. Although there were already proposals for dose reduction before the corona pandemic and the associated supply bottlenecks, this situation led to the use of a reduced amount of contrast agent on a large scale. This presents a good opportunity to reconsider protocols and the use of contrast-enhanced imaging in general for future practice as it offers chances and advantages regarding costs, environmental impact, and patient safety.
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Affiliation(s)
- David R Koeppel
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Ingrid B Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland.
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DRESS syndrome due to iodinated contrast media. A case report. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:16. [PMID: 36849962 PMCID: PMC9972718 DOI: 10.1186/s13223-023-00774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The most frequent non-immediate reactions described with iodinated contrast media (ICM) are mild to moderate, however, some cases of patients with severe non-immediate reactions, such as drug eruption with eosinophilia and systemic symptoms (DRESS) have been described. CASE PRESENTATION An 84-year-old patient developed DRESS syndrome after administration of ICM ioversol. The patient fullfilled the RegiSCAR diagnostic criteria for DRESS (definite score = 6). He underwent intradermal skin testing (IDT) with the widest panel of ICM available at our center. IDT was positive with ioversol and iomeprol. A punch biopsy was performed on the positive IDT with the culprit drug (ioversol) and histopathology was compatible with a T-cell mediated mechanism. CONCLUSION In this case, the IDT-positive biopsy was consistent with DRESS syndrome caused by T-lymphocyte activation, supporting the clinical diagnosis.
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Ma Z, Jin L, Zhang L, Yang Y, Tang Y, Gao P, Sun Y, Li M. Diagnosis of Acute Aortic Syndromes on Non-Contrast CT Images with Radiomics-Based Machine Learning. BIOLOGY 2023; 12:biology12030337. [PMID: 36979029 PMCID: PMC10045362 DOI: 10.3390/biology12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
We aimed to detect acute aortic syndromes (AAS) on non-contrast computed tomography (NCCT) images using a radiomics-based machine learning model. A total of 325 patients who underwent aortic CT angiography (CTA) were enrolled retrospectively from 2 medical centers in China to form the internal cohort (230 patients, 60 patients with AAS) and the external testing cohort (95 patients with AAS). The internal cohort was divided into the training cohort (n = 135), validation cohort (n = 49), and internal testing cohort (n = 46). The aortic mask was manually delineated on NCCT by a radiologist. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used to filter out nine feature parameters; the Support Vector Machine (SVM) model showed the best performance. In the training and validation cohorts, the SVM model had an area under the curve (AUC) of 0.993 (95% CI, 0.965–1); accuracy (ACC), 0.946 (95% CI, 0.877–1); sensitivity, 0.9 (95% CI, 0.696–1); and specificity, 0.964 (95% CI, 0.903–1). In the internal testing cohort, the SVM model had an AUC of 0.997 (95% CI, 0.992–1); ACC, 0.957 (95% CI, 0.945–0.988); sensitivity, 0.889 (95% CI, 0.888–0.889); and specificity, 0.973 (95% CI, 0.959–1). In the external testing cohort, the ACC was 0.991 (95% CI, 0.937–1). This model can detect AAS on NCCT, reducing misdiagnosis and improving examinations and prognosis.
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Affiliation(s)
- Zhuangxuan Ma
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
| | - Liang Jin
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
- Radiology Department, Huashan Hospital, Affiliated with Fudan University, Shanghai 200040, China
- Correspondence: (L.J.); (M.L.); Tel.: +86-13761148449 (L.J.); +86-13816620371 (M.L.); Fax: +86-021-62483180 (L.J. & M.L.)
| | - Lukai Zhang
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
| | - Yuling Yang
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
| | - Yilin Tang
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
| | - Pan Gao
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
| | - Yingli Sun
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
| | - Ming Li
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai 200040, China
- Institute of Functional and Molecular Medical Imaging, Shanghai 200040, China
- Correspondence: (L.J.); (M.L.); Tel.: +86-13761148449 (L.J.); +86-13816620371 (M.L.); Fax: +86-021-62483180 (L.J. & M.L.)
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Evaluation of Iodinated Contrast Media Use in Abdominal CT Scans in Cancer Assessments: A Cross-Sectional Study in Lomé (Togo). Radiol Res Pract 2023; 2023:8296467. [PMID: 36644494 PMCID: PMC9836791 DOI: 10.1155/2023/8296467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
Background There is great variability between centers regarding contrast injection protocols. They should only be injected if they can provide useful information for diagnosis with the necessary and sufficient quantity of iodine. We wanted to know through this study if the use of iodinated contrast media is optimised in abdominal CT scans performed for cancer assessment in Lomé. Materials and Methods It was a cross-sectional, descriptive, and analytical study with a prospective collection over a period of 6 months in three CT units in Lomé. It involved abdominal CT scans performed for oncological evaluation. Data were reported as the mean ± standard deviation. The Pearson correlation coefficient, ANOVA, chi-square, and the Fisher test were used. Results A total of 218 examinations were recorded. The female sex represented 56.88% of the patients. The mean age was 50.92 ± 15.78 years. The mean weight was 70.46 ± 15.23 kg. The mean BMI was 24.91 ± 5.32 kg/m2. The examinations were performed with a voltage of 120 kV in 195 cases (89.45%). The mean dose of injected iodine was 0.42 ± 0.09 gI/kg with a dose of 0.40 gI/kg at 80 kV and 0.45 gI/kg at 130 kV. The mean injection rate was 2.90 ± 0.34 mL/s. The mean injected volume was 83.19 ± 7.29 mL. The mean duration of the injection was 30.60 ± 7.39 s. The mean iodine delivery rate was 0.98 ± 0.17 gI/s. There was no saline injection in 152 cases (69.72%). Liver contrast enhancement was satisfactory in 94.5% of cases. There was a strong negative linear correlation between the dose of injected iodine and weight. Conclusions Optimization guidelines for the use of iodinated contrast media are not always applied. Therefore, monitoring and benchmarking programmes for iodinated contrast injection protocols that involve all radiology personnel should be implemented.
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Macy E, Trautmann A, Chiriac AM, Demoly P, Phillips EJ. Advances in the Understanding of Drug Hypersensitivity: 2012 Through 2022. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:80-91. [PMID: 36384652 DOI: 10.1016/j.jaip.2022.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Over the last decade there have been key advances in understanding mechanisms, risk, and consequences of both true immunological drug hypersensitivity and unverified drug allergy labels that have changed clinical practice. This has been facilitated by the widespread adoption of electronic health records (EHRs). The vast majority of EHR drug allergy labels are unverified and cause significant morbidity from unnecessary avoidance of optimal drug therapy. There has also been significant movement in our understanding of mechanisms of drug hypersensitivity that, in addition to advancing our understanding of the pathogenesis of immediate and delayed reactions, have guided preventive efforts, diagnostic procedures, and clinical management. More widespread adoption, including scale-up of "allergy" delabeling and appropriate management, specifically for antibiotics, opiates, radiocontrast, chemotherapeutics, biologics, and nonsteroidal anti-inflammatory medications, will be necessary to improve patient outcomes over the next decade. This will require further engagement and collaboration between primary care health care providers, allergists, and other specialists.
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Affiliation(s)
- Eric Macy
- Allergy Department, Kaiser Permanente Southern California, San Diego, Calif.
| | - Axel Trautmann
- Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Anca M Chiriac
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, Paris, France; IDESP, UMR UA11, Univ. Montpellier-INSERM, Montpellier, France
| | - Pascal Demoly
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, Paris, France; IDESP, UMR UA11, Univ. Montpellier-INSERM, Montpellier, France
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
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Qiu L, Cui Q, Gong X, Zhou H. Anaphylaxis Following Contrast-Enhanced CT with Iodixanol: A Case Report and Literature Review. J Asthma Allergy 2023; 16:195-200. [PMID: 36721740 PMCID: PMC9884438 DOI: 10.2147/jaa.s386811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Background Iodixanol-induced anaphylactic reaction is a well-known adverse event of contrast agents, which are generally well-tolerated and reversible. Serious and fatal reactions such as anaphylactic shock after computed tomography (CT) enhancement have been described. However, there is no data on these events in the literature. Objective This report describes a case of a serious anaphylactic reaction, possibly related to iodixanol and provides an overview of case reports. Case Summary A 47-year-old women who experienced persistent abdominal pain for more than one month, was proposed of hiatal hernia with CT images taken two weeks previously and was admitted to the gastrointestinal surgery department. The patient underwent contrast-enhanced abdominal CT for the evaluation of multiple intraperitoneal hemodynamic features. A few minutes after abdominal enhanced CT scan, the patient was pale, sweating, had muscle tension and trembling, even coma and profound hypotension with 90/43 mm Hg. Immediately she was supported with oxygen inhalation, was treated with adrenaline subcutaneously, dexamethasone intravenously, and rapid intravenous drip of compound sodium chloride. Ten minutes later, the patient was in respiratory and cardiac arrest and the pupils were dilated. CPR and intermittant static push of 1 mg adrenaline were immediately carried. After endotracheal intubation, the patient's spontaneous heart rate and pupils recovered, and her blood pressure recovered to 105/53 mm Hg. It was suggested that the patient was suffering from iodixanol-induced anaphylactic shock and nephropathy, and she was transferred to the intensive care unit. Despite immediate treatment, the patient died. Conclusion A 47-year-old female patient with no history of allergies developed severe fatal anaphylactic shock after receiving iodixanol. Although contrast agents induced anaphylactoid/anaphylactic reactions do not often occur, clinicians should be conscious of the potentially serious anaphylactic reaction, which could lead to a life-threatening or fatal event.
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Affiliation(s)
- Lin Qiu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qihao Cui
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xuepeng Gong
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Haiyun Zhou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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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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Gamboa P, Sánchez de Vicente J, Galán C, Jáuregui I, Segurola A, García-Lirio E, Seras Y, Martínez-Antón MD, Arrien de Lecea A. Non-immediate hypersensitivity reactions to iomeprol: Diagnostic value of skin tests and cross-reactivity with other iodinated contrast media. Allergy 2022; 77:3641-3647. [PMID: 35815908 DOI: 10.1111/all.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/28/2022] [Accepted: 06/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Iodinated contrast media produce non-immediate hypersensitivity reactions (NIHR). The goal of this prospective study was to determine the utility of skin tests and the subsequent tolerance to negative skin-tested iodinated contrasts in patients with NIHR caused by iomeprol. METHODS Prick and intradermal tests with iomeprol, iopamidol, iopromide, and iobitridol were performed in all patients. IV challenge with the causative contrast (iomeprol in 90%) was made if skin tests were negative. In case of a positive skin test with the causal contrast, or a positive challenge test with it, IV challenge test with an alternative, negative skin-tested contrast was performed in all patients. RESULTS Skin tests were positive in 47.6% (20/42) of patients with NIHR induced by iomeprol. Of the 66 challenge tests performed with negative skin-tested iodinated contrasts, tolerance was confirmed in 35 (53%): 32 iomeron, 2 iobitridol, 1 iopamidol. Cross-reactivity between iomeprol and iopamidol was 22% (4/20 in patients with positive skin tests and 5/21 in patients with negative skin tests). CONCLUSIONS Sensitivity of the skin tests was less than 50% NIHRs due to iomeprol, while the negative predictive value of skin tests in patients who tolerated challenges with alternative contrasts (mainly iopamidol) was 53% (35 tolerated out of 66 performed). The cross-reactivity between iomeprol and iopamidol is high.
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Affiliation(s)
- Pedro Gamboa
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
| | - Javier Sánchez de Vicente
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
| | - Cristina Galán
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain
| | - Ignacio Jáuregui
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
| | - Aritza Segurola
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
| | - Eduardo García-Lirio
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
| | - Yolanda Seras
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
| | - Mª Dolores Martínez-Antón
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
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Madrigal-Burgaleta R. The Path to Optimal Evaluation of Anaphylactic Iodinated Contrast Media Reactions: Are We There Yet? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2693-2694. [DOI: 10.1016/j.jaip.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022]
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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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Srisuwatchari W, Vo T, Gauthier A, Molinari N, Schrijvers R, Demoly P, Chiriac AM. Hypersensitivity reactions to iodinated radiocontrast media: Cluster analysis reveals distinct clinical phenotypes. World Allergy Organ J 2022; 15:100680. [PMID: 36092950 PMCID: PMC9440439 DOI: 10.1016/j.waojou.2022.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Drug hypersensitivity reaction (DHR) to iodinated radiocontrast media (iRCM) is reported in 1%–3% of injections. Risk assessment of patients with suspicion of DHR to iRCM relies solely on clinical phenotyping and drug allergy workup. Using a novel unsupervised TwoStep cluster analysis, we aimed to identify prototypic patterns within a large cohort of patients evaluated for a potential iRCM DHR. Methods A retrospective study was conducted using data from the Drug Allergy and Hypersensitivity Database of the Allergy Unit, University Hospital of Montpellier, Montpellier, France. All referred patients during February 2001 to December 2019 with suspicion of iRCM DHR with either confirmed positive or confirmed negative skin tests were included in the analysis. Results A total of 1439 patients were evaluated. The chronology of the index reaction was immediate and nonimmediate in 77.1% and 22.4%, respectively. Cluster analysis categorized the total study population in 5 clusters. Cluster 1 compiled all nonimmediate and cluster 2–5 almost all immediate reactors. Cluster 1 and 2 had recent reactions (<1 y) with mostly known iRCMs and the highest iRCM allergy prevalence (16–17%). In the other clusters, more remote reactions, unknown iRCMs and a lower allergy prevalence (3–8%) was observed. Chronology and semiology of the index reaction were the factors most strongly differentiated among clusters. History of anaphylactic shock and chronology of immediate hypersensitivity reactions were shown to be independent predictors of allergy with adjusted OR (aOR) of 4.68 (95%CI: 3.01–7.27, p < 0.001) and 2.51 (95%CI: 1.67–3.78, p < 0.001), respectively. Conclusions Unsupervised cluster analysis identified 5 prototypic patterns within patients with a suspected DHR to iRCMs. Well-phenotyped patients cluster together in 2 groups in which the prevalence of allergy is approximately 1 in 6. However, this value decreases for patients with reactions dating back to more than a decade.
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Kim SR, Son NH, Park HJ, Park KH, Park JW, Lee JH. Differences in the Recurrence Rate of Immediate Adverse Drug Reactions According to the Components of Alternative Contrast Media: Analysis of Repetitive Computed Tomography Cases in a Single Tertiary Hospital. Drug Saf 2022; 45:995-1002. [PMID: 35908149 DOI: 10.1007/s40264-022-01213-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The recurrence rates of immediate adverse drug reactions (ADRs) to the alternative radiocontrast media (RCM) are not well known. Previous studies suggest selection of alternative RCM considering carbamoyl side chains; however, its usefulness for preventing the recurrence of ADRs has not been clearly verified. OBJECTIVE The aim of this study was to verify the recurrence rate of immediate ADRs according to the alternative RCM. METHOD This retrospective study analyzed 6420 contrast-enhanced computed tomography (CT) cases of 2009 patients registered in the ADR system from 861,664 CT cases in a single tertiary hospital between 2015 and 2020. Iohexol, iopromide, iobitridol, and iopamidol were used for CT. According to the carbamoyl side chains present, iohexol belongs to group 1, iopromide belongs to groups 1 and 2, iobitridol belongs to group 2, and iopamidol belongs to group 3. RESULTS Replacing iobitridol with iopamidol (odds ratio [OR] 2.595, 95% confidence interval [CI] 1.48-4.550) or iopromide (OR 3.354, 95% CI 1.420-7.926) as the subsequent RCM was associated with increased recurrence, while replacing iopamidol with iobitridol (OR 0.506, 95% CI 0.282-0.908) and iopromide with iohexol (OR 0.355, 95% CI 0.177-0.711) was associated with decreased recurrence. Other changes did not influence the recurrence of ADRs. CONCLUSIONS The recurrence of immediate ADRs increased in certain RCM combinations of preceding and subsequent CT scans, and the RCMs did not show cross-reactivity. Therefore, the clinical benefit of the alternative RCM considering cross-reactivity is limited. This result suggests that the side chains of RCM do not have an important role in the recurrence of immediate ADRs.
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Affiliation(s)
- Sung-Ryeol Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Kyounggi-do, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Boehm IB. To crack a nut with a sledgehammer: premedication in a patient with a history of mild symptoms following the injection of a contrast agent. Quant Imaging Med Surg 2022; 12:4005-4006. [PMID: 35782240 PMCID: PMC9246732 DOI: 10.21037/qims-22-256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2023]
Affiliation(s)
- Ingrid B Boehm
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
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Endrikat J, Chernova J, Gerlinger C, Pracz M, Lengsfeld P, Bhatti A, Michel A. Risk of Hypersensitivity Reactions to Iopromide in Children and Elderly: An Analysis of 132,850 Patients From 4 Observational Studies and Pharmacovigilance Covering >288 Million Administrations. Invest Radiol 2022; 57:318-326. [PMID: 34860739 PMCID: PMC8983946 DOI: 10.1097/rli.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/01/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to analyze the risk of hypersensitivity reactions (HSRs) to iopromide in children and elderly patients in comparison to adults. MATERIALS AND METHODS Four observational studies were pooled and analyzed (analysis I). In addition, spontaneous reports from 1985 to 2020 from the pharmacovigilance database were evaluated (analysis II). All patients received iopromide for angiographic procedures or contrast-enhanced computed tomography in various indications. In analysis I, a nested case-control analysis, including a multivariable logistic regression model, based on pooled observational study data, was performed. Cases were defined as patients with a typical and unequivocal HSR; controls were patients without any recorded reaction. In analysis II, all spontaneous reports on HSRs after iopromide administration recorded in the pharmacovigilance database were descriptively analyzed. Exposure estimates on the size of the exposed age groups were derived from sales data and data from market research. The primary target variable was the risk of HSR to iopromide in children (<18 years) and elderly patients (≥65 years) compared with adults (≥18 to <65 years). RESULTS In analysis I, a total of 132,850 patients were included (2978 children, 43,209 elderly, and 86,663 adults). Hypersensitivity reactions were significantly less frequent in children (0.47%) and elderly (0.38%) compared with adults (0.74%). The adjusted odds ratio (vs adults) for children was 0.58 (95% confidence interval, 0.34-0.98; P < 0.043), and that for the elderly was 0.51 (95% confidence interval, 0.43-0.61; P < 0.001), indicating a lower risk for both subpopulations as compared with adults. In analysis II, of the overall >288 million iopromide administrations, 5.87, 114.18, and 167.97 million administrations were administered to children, elderly, and adults, respectively. The reporting rate for HSRs in children (0.0114%) and elderly (0.0071%) was significantly lower as compared with adults (0.0143%) (P < 0.0001). CONCLUSIONS Hypersensitivity reactions to iopromide were significantly less frequent in children and elderly compared with adults.
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Affiliation(s)
- Jan Endrikat
- From the Bayer AG, Radiology R&D, Berlin
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar
| | | | - Christoph Gerlinger
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar
- Bayer AG, Statistics & Data Insights
| | | | | | - Aasia Bhatti
- Bayer US LLC, Benefit Risk Management Pharmacovigilance
| | - Alexander Michel
- Bayer Consumer Care AG, Division Pharmaceuticals, Integrated Evidence Generation, Basel, Switzerland
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Chiu TM, Chu SY. Hypersensitivity Reactions to Iodinated Contrast Media. Biomedicines 2022; 10:1036. [PMID: 35625773 PMCID: PMC9138609 DOI: 10.3390/biomedicines10051036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [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
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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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Contrast Medium Hypersensitivity: A Large Italian Study with Long-Term Follow-Up. Biomedicines 2022; 10:biomedicines10040759. [PMID: 35453509 PMCID: PMC9028178 DOI: 10.3390/biomedicines10040759] [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: 03/04/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 12/20/2022] Open
Abstract
Hypersensitivity reactions (HRs) to contrast media (CM) are a major problem. We compared differences of HRs to iodinated contrast media (ICM) versus gadolinium-based contrast media (GBCM), collecting data on prevalence, type, latency and severity. Secondly, the predisposition to perform new contrast tests, use of premedication and possible appearance of new reactions were explored in a long-term follow-up of 5 years. Clinical data, comorbidities, skin test (ST) results, re-exposure to CM procedures with any new reactions, premedication and CM used were collected. In a retrospective single-center study, 350 patients with mild to moderate HRs were enrolled. Asthma, food allergy, non-allergic drug hypersensitivity and neurologic disease were significantly more frequent in patients with HRs to GBCM compared to the high evidence of cardiovascular disease and history of cancer in patients with HRs to ICM. A marked delay in performing STs was reported by patients with negative results (66 months, p < 0.01). Iomeprol, iopamidol and gadobenic acid were the culprit CM most involved in HRs in patients with positive STs. During follow-up, 7.1% of responders reported new HRs to CM despite negative STs, premedication and infusion of alternative CM in most cases.
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