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Palabras clave: Gadobutrol. Hipersensibilidad a contrastes de gadolinio. Reactividad cruzada entre contrastes de gadolinio. Medios de contraste paramagnéticos. Gadolinium-based contrast media have been used for 25 years for contrast-enhanced magnetic resonance imaging (MRI) because of their safety and low rates of adverse effects (0.3%) [1]. The incidence of immediate hypersensitivity reactions to magnetic resonance contrast media is 0.079% in adults and 0.04% in children [2]. Reactions have been reported more frequently for abdominal explorations (0.01%) than for explorations of the brain (0.005%) and spine (0.003%). The most common reaction is urticaria (50%-90% of cases), while anaphylaxis has an incidence of 0.004% to 0.01%. These contrast media can be classified based on their net charge as ionic or nonionic and on their structure as linear or macrocyclic [1,2]. A 45-year-old man diagnosed with astrocytoma was sent to our Allergy Unit because he developed facial edema, generalized erythema, dyspnea, rhinitis, and edema in his hands and feet 5 minutes after starting an infusion with gadobutrol. The infusion was stopped immediately, and he was treated with parenteral methylprednisolone and dexchlorpheniramine. He had received this contrast media previously without adverse reactions. An allergy study was programmed once informed consent was obtained. Since the patient did not wish to undergo tests involving gadobutrol, we carried out prick and intradermal tests with other gadolinium-based contrast media (Table). The patient had to receive a gadolinium contrast media for disease control; therefore, we proposed a challenge test with gadoteridol, because the results of the prick and intradermal tests were negative and positive with other agents. Twenty-five minutes after administration, the patient began to experience facial erythema, palmar pruritus, tinnitus, urticaria on his arms and knees, and mild dyspnea. He was treated immediately with parenteral epinephrine, methylprednisolone, and dexchlorpheniramine. Hypersensitivity reactions with gadolinium-based contrast agents are very rare, with very few cases reported in the literature. In 2007, Kalogeromitros et al [3] reported a case of anaphylaxis after infusion of gadobenate with a positive intradermal test result. Hasdenteufel et al [4] reported 2 cases of anaphylactic shock with positive results in skin tests with Manuscript

barnacle could induce IgE-mediated adverse reaction. Our study has demonstrated the presence of an IgE-binding protein in barnacle extracts ranged between 58 and 68 kDa of molecular mass. It has not been previously described a crustacean allergen with the same molecular mass, so it could be a specific allergen from barnacle. We believe that further study will confirm this is the case.

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