A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions

Abstract

The terms "immediate" and "delayed" adverse reactions induced by contrast media (CM) refer to the reactions' onset but do not provide substantial information concerning the clinical manifestation, the potential risk factors, the treatment modalities, or prevention. Because a variety of different reactions caused by different pathophysiological mechanisms may arise immediately or be delayed after CM injection, and because these need different management, the aim of the present paper is to present the clinical features and to exactly characterize lesser-known cutaneous reactions. A thorough knowledge of the clinical features, their adequate treatment, and, possibly, the subsequent diagnostic procedure for preventing recurrence after reexposure to CM would improve patient management.

Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence

“…As expected, in the presented case the prick test was negative. The current understanding of the pathophysiology of the delayed skin reactions suggests that these skin reactions are T-cell mediated (type VI hypersensitivity reactions) [11,[23][24][25].…”

“…Delayed skin reactions can be further classified as erythema, urticaria, maculo-papular exanthema and fixed drug eruption (FDE) [1,2,11]. Besides the academic interest, this classification is of some importance to choose an adequate treatment and diagnostic procedure and to estimate the actual risk for recurrence after re-exposure to a CM.…”

Recent hot topics in contrast media

“…Contrast medium induced adverse reactions continue to be a problem [26]. They are unpredictable and diverse in nature.…”

Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity

“…Until recently, iodinated contrast media were believed to induce mainly non-specific immediate reactions described as erythema or flushing, feeling hot, malaise, tremor and/or nausea; only in recent years has the immune nature of many of these immediate reactions, particularly anaphylactic events, been recognised, as emphasised by Bö hm [4] and other authors [5]. Where non-specific histamine-release agents, such as iodinated contrast media are concerned, true immune hypersensitivity reactions may easily be mistaken, as occurred in the first coronary angiography in our patient.…”