Delayed hypersensitivity to X-ray CM: Possible mechanisms and models

Speck, Ulrich; Böhle, Florian; Krause, W.; Martin, Jose L.; Miklautz, Heribert; Schuhmann-Giampieri, Gabriele

doi:10.1016/s1076-6332(98)80093-7

Cited by 12 publications

(7 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It binds to high affinity receptors on the surface of mast cells or basophils and, in Coombs and Gell's type-I reactions, when a divalent allergen bridges two IgE molecules, it triggers cell degranulation and release of mediators such as histamine [91]. The existence of molecular aggregates consisting of several hundred molecules has been proposed [92] but subsequently invalidated [93]. The existence of molecular aggregates consisting of several hundred molecules has been proposed [92] but subsequently invalidated [93].…”

Section: Theories Regarding Acute Reactionsmentioning

confidence: 99%

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

Idée

Pinès

Prigent

et al. 2005

Fundamemntal Clinical Pharma

View full text Add to dashboard Cite

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.

show abstract

Section: Theories Regarding Acute Reactionsmentioning

confidence: 99%

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

Idée

Pinès

Prigent

et al. 2005

Fundamemntal Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Data obtained with photon correlation spectroscopy have been interpreted as evidence for the presence of large aggregates or colloids in the tested CM solutions [65,66], and it has been postulated that these aggregates could link adjacent cell surface bound IgE molecules and thereby cause a type-I reaction [65,67]. The interpretation of the photon correlation spectroscopy data could, however, be argued against.…”

Section: Ige-mediated Reactionmentioning

confidence: 99%

Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations

Christiansen¹,

Pichler

Skotland³

2000

European Radiology

127

View full text Add to dashboard Cite

Iodinated X-ray contrast media are among the most frequently used pharmaceuticals for intravascular administration. Although the newer low osmolality, nonionic contrast media, are generally well tolerated, it is well known that they, like the ionic contrast media, give rise to immediate or delayed adverse reactions in susceptible individuals. In the present review, the delayed allergy-like reactions, which by definition occur more than 1 h after contrast medium administration, are described, and the possible pathophysiological mechanisms discussed. Delayed allergy-like reactions to contrast media, which have been reported to occur in 0.5-2% of recipients, are mainly mild to moderate skin reactions of the maculopapular exanthematous and urticarial/angioedematous types. Most of the reactions become apparent after a latency of 3 h to 2 days and disappear within 1 week. The incidence of more severe reactions is extremely low. Main risk factors for delayed allergy-like reactions appear to be a previous contrast medium reaction, a history of allergy, IL-2 treatment and being of Japanese descent. At present, the exact pathogenesis of these delayed reactions is still unclear. There is, however, increasing evidence that a significant proportion of the reactions are T-cell mediated.

show abstract

“…A lthough iodinated contrast agents are considered safe, side effects remain an important issue (1)(2)(3). The introduction of nonionic monomeric contrast agents significantly reduced the number of side effects (4,5).…”

mentioning

confidence: 99%

“…The introduction of nonionic monomeric contrast agents significantly reduced the number of side effects (4,5). With respect to osmolality and chemotoxicity, further progress has been made with the synthesis of dimeric nonionic contrast agents, which, despite their higher price, are now used intravascularly with increasing frequency worldwide (3). Nonionic dimeric contrast agents induce less diuresis and are associated with less vasodilatation (6)(7)(8).…”

mentioning

confidence: 99%