The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported. Key words: Iodinated. Gadolinium. Contrast media. Allergy. Hypersensitivity. Anaphylaxis. Immediate reactions. Nonimmediate reactions. PrologueThe objective of these guidelines is to ensure efficient and effective clinical practice in the diagnosis and management of hypersensitivity reactions to radiologic contrast media. The guidelines were developed by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) with extensive clinical expertise in the evaluation and management of hypersensitivity reactions and broad research experience.We performed a systematic and independent review of the literature up to November 2015 and established a consensus of expert opinion. We evaluated the applicability of the guidelines in our daily clinical practice. The guidelines were evaluated and criticized by external reviewers with expertise in the field. MethodThe panel of experts who produced this consensus document developed a research protocol outlining the background to the subject of study, the objectives of the study, and the questions and hypotheses from which search criteria were defined.The main sources used for the literature search included electronic databases and archives (MEDLINE-PubMed, Science Direct, OVID) and a database of systematic re...

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The autologous serum skin test (ASST) has been widely used to try to demonstrate autorreactivity in chronic urticaria (CU), but the possible correlation with the long-term clinical course of the disease is unknown. Our objective was to evaluate if there were clinical and sociodemographic differences between patients affected by CU after five years of follow-up, according to the positive or negative results of the ASST. METHODS: Clinical and sociodemographic data of patients diagnosed with CU and ASST performed in our hospital between 2009 and 2014, were reviewed. Age, gender, refractoriety to treatment, disease duration, development of thyroiditis and other autoimmune diseases were analyzed and compared between the positive (ASST+) and negative (ASST-) ASST groups. RESULTS: 71 patients, 50 females and 21 males, with an average age of 52.8 years were selected. There were no significant differences in age and sex between the groups. In the ASST+ group, 45% of CU were refractory to the standard treatment (double dose of antihistamines) and 81% of CU were persistent after 3-5 years vs. 6% and 21% in the ASST-group, respectively. After five years, 25% of ASST+ patients were diagnosed with an autoimmune disease and 25% of these had autoimmune thyroiditis vs. 8.5% and 14%, respectively, for ASST-patients. Helicobacter Pylori was detected in 60% of ASST+ patients vs. 4.7% of ASST-patients. CONCLUSIONS: ASST could represent a useful and cheap tool as a prognostic factor for the duration and severity of CU in clinical practice, although further investigation is needed.