Arch Hellen Med, 34(1), January-February 2017, 104-112
Hypersensitivity reactions to radiocontrast media: Readministration based on allergic evaluation
M. Potika,1 M. Makris,1 I. Kontogiorgaki,1 C. Sandilos,1 X. Aggelides,1 C. Koulias,1 C. Chliva,1 E. Tiligada,1,2 D. Rigopoulos1
OBJECTIVE Allergic evaluation of hypersensitivity reactions (HRs) to radio iodinated contrast media (ICM) and study of the outcome of readministration based on the results of skin testing.
METHOD All patients with a HR to an ICM during or up to 7 days after infusion over a 5-year period were included in the study. The participants were evaluated by a detailed history of drug allergy, and skin testing (skin prick tests, intradermal and patch tests) with a broad range of ICM agents. A telephone questionnaire was subsequently administered to all responders to record the outcome of readministration of ICM after the evaluation and consultation based on the results.
RESULTS The study included 90 patients (47 women, 52%), aged 54±15 years. Of these, 26 of 72 (36%) had had no prior use of ICM. Of the 90, 38 (42.2%) reported an immediate reaction and 50 (56.6%) a delayed reaction, while 2 (2.2%) could not recall details of the reaction. The most common manifestations overall were maculopapular rash (43.3%) and urticaria/angioedema (27.8%). Among the immediate reactions anaphylaxis (38.9%) and urticaria/angioedema (36.1%) were the most common and among the delayed reactions maculopapular rash (75%) and delayed urticaria (21.2%) were the most commonly reported. Iodixanol was the agent causing the reaction in most cases (36.7%). In 32/90 patients (35.6%), the ICM could not be definitely incriminated from the history. Of the 90 participants, 42 (46.7%) underwent skin testing: In 8 (19%), the results were positive and in 34 (81%) negative. The percentage of positive skin tests was 17% in immediate and 21% in delayed HRs, respectively. The average time from the reaction for the skin tests to be conducted was 5.7±4.6 months for positive and 41±70 months for negative results. In 20.6%, ICM was readministered according to advice based on the skin testing results without reoccurence of HR.
CONCLUSIONS Allergy testing is useful in the diagnostic evaluation of both immediate and delayed reactions in IPM. The allergic evaluation is more sensitive and reliable when performed within a short time period of the reaction.
Key words: Allergy, Hypersensitivity reaction, Radiocontrast media.