Comment explorer l’ototoxicité des solvants dans le cadre d’études épidémiologiques

Allergy-like reactions may occur following administration of iodinated contrast media (CM), mostly in at-risk patients (patients with history of previous reaction, history of allergy, co-treated with interleukin-2 or beta-blockers, etc.) but remain generally unpredictable. Severe and fatal reactions are very rare events. All categories of CM may induce such reactions, although first generation (high osmolar CM) have been found to induce a higher rate of adverse events than low osmolar CM. However, no differences were found between the two categories of CM with respect to mortality. Delayed reactions can also occur. There are no differences between the various categories of CM except for non-ionic dimers, which are more likely to induce such effect. Numerous clinical studies have evaluated the prophylactic value of drugs (mostly antihistamines and corticosteroids). Results are unclear and highly variable. Any prevention depends upon the mechanism involved. However, the mechanism of CM-induced allergy-like reaction remains disputed. Relatively recent data revived the hypothesis of a type-I hypersensitivity mechanism. Positive skin tests to CM have been reported. However, the affinity of IgE towards CM has been found to be very low in the only study which actually evaluated it. Other pathophysiological mechanisms (involving direct secretory effects on mast cells or basophils, or activation of the complement system associated or not with the plasma contact system) are also much debated. Anaphylaxis and anaphylactoid reactions are, in the end, clinically undistinguishable.

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Late skin reaction to iodixanol (Visipaque^®): clinical manifestations, patch test study, and histopathological evaluation

Delgado‐Jiménez

Pérez‐Gala

Aragüés

et al. 2006

Contact Dermatitis

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Late reactions to iodinated contrast media are frequent. Cutaneous manifestations are the commonest, in which maculopapular exanthema, a type of cutaneous presentation, is widespread. Controversy exists about the utility of the skin test in the management of these reactions. The aim of this study is to analyse the clinical characteristics, the histopathological findings, and the results of the patch test in patients who developed a late skin reaction (LSR) to the nonionic, dimeric, iodinated contrast media Visipaque. We retrospectively reviewed the patients with LSR to Visipaque, seen in the Dermatology Department between 1999 and 2005. A total of 12 patients participated in this study (7 men and 5 women), ages ranging from 39 to 76 years (mean 56). 11 of the patients had significant medical history. All the patients developed a maculopapular exanthema between 2 hr and 3 days after the radiological examination, involving the trunk and proximal limbs, although some of the patients showed involvement of distal areas. The skin biopsy, performed in 6 patients, showed nonspecific findings consistent with drug reaction. In 3 patients, patch tests to Visipaque and iodixanol were positive. The most frequent manifestation of LSR to iodixanol is a maculopapular exanthema, involving the trunk and the limbs, although distal involvement can be seen. Histopathological findings are nonspecific and cannot be distinguished from other drug reaction. Patch tests have a limited value, and in cases where they were negative, reintroduction of the drug triggered a new LSR.

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Comment explorer l’ototoxicité des solvants dans le cadre d’études épidémiologiques

Cited by 3 publications

References 14 publications

DRESS syndrome induced by sodium meglumine ioxitalamate

DRESS syndrome induced by sodium meglumine ioxitalamate

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Late skin reaction to iodixanol (Visipaque^®): clinical manifestations, patch test study, and histopathological evaluation

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Comment explorer l’ototoxicité des solvants dans le cadre d’études épidémiologiques

Cited by 3 publications

References 14 publications

DRESS syndrome induced by sodium meglumine ioxitalamate

DRESS syndrome induced by sodium meglumine ioxitalamate

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Late skin reaction to iodixanol (Visipaque®): clinical manifestations, patch test study, and histopathological evaluation

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Late skin reaction to iodixanol (Visipaque^®): clinical manifestations, patch test study, and histopathological evaluation