Skin reaction to contrast medium

Gonzalo-Garijo, M A; Argila, D. de; Pimentel, Joaquin; Alejo, M.; García-Menaya, Jesús Miguel

doi:10.1111/j.1398-9995.1997.tb02164.x

Cited by 9 publications

(8 citation statements)

References 3 publications

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“…There have been 10 reported cases of fixed drug eruption (FDE) secondary to ICM identified in the literature (Table ) . Six occurred following a computed tomography (CT) scan and the culprit ICM in over half of cases was a nonionic monomeric medium .…”

Section: Reactions To Iodinated Contrast Mediamentioning

confidence: 99%

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

et al. 2019

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Contrast media (CM) are an indispensable part of modern medical imaging. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 covers the classification of CM, immediate hypersensitivity reactions to CM and the newly described condition, gadolinium deposition disease. Given that there has only been two case reports to our knowledge of a delayed adverse reaction to gadolinium-based CM, this second part will focus on cutaneous delayed reactions caused by iodinated CM (ICM). Delayed hypersensitivity reactions to ICM commonly present as maculopapular exanthems, but more rarely, they can manifest as fixed drug eruptions, acute generalized exanthematous pustulosis, drug-related eosinophilia and systemic symptoms, Stevens-Johnson syndrome/ toxic epidermal necrolysis, symmetrical drug-related intertriginous and flexural exanthema, graft-versus-host disease, vasculitis and iododerma. Delayed reactions to ICM may be underdiagnosed, as cutaneous symptoms may be attributed to oral medications, particularly if patients are on multiple drugs.

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Section: Reactions To Iodinated Contrast Mediamentioning

confidence: 99%

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

et al. 2019

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“…Most of the CM‐induced nonimmediate skin eruptions appear to be T‐cell mediated allergic reactions as shown by (i) the frequently reported positive patch tests (PT) and delayed intradermal tests (IDT) to the culprit CM in previous reactors (18, 42–58), (ii) the presence of dermal infiltrates of T cells in affected skin and positive skin test sites (42–49, 54, 56, 58–60), (iii) the reappearance of the eruption after provocation testing (45–47), and (iv) the ability of CM to stimulate proliferation of peripheral T cells from patients with CM‐induced skin eruptions (53, Pichler et al unpublished data).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Histological examination of biopsy samples from nonimmediate skin eruptions has occasionally been conducted. In cases of fixed drug eruption (FDE), the affected skin showed lymphocyte infiltration of the dermis and epidermis, epidermal spongiosis and necrosis, as well as hydropic degeneration of the basal layer (42, 43, 59). Other reported findings were neutrophilic abscess within the stratum corneum and pronounced eosinophilic degeneration.…”

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confidence: 99%

Management of hypersensitivity reactions to iodinated contrast media

Brockow

Christiansen²,

Kanny³

et al. 2005

Allergy

258

256

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All iodinated contrast media (CM) are known to cause both immediate (≤1 h) and nonimmediate (>1 h) hypersensitivity reactions. Although for most immediate reactions an allergic hypersensitivity cannot be demonstrated, recent studies indicate that the severe immediate reactions may be IgE‐mediated, while most of the nonimmediate exanthematous skin reactions, appear to be T‐cell mediated. Patients who experience such hypersensitivity reactions are therefore advised to undergo an allergologic evaluation. Several investigators have found skin testing to be useful in confirming a CM allergy, especially in patients with nonimmediate skin eruptions. If a patient with confirmed allergy to a CM needs a new CM exposure, a skin test negative CM should be chosen and premedication may be tried. However, none of these precautional measures is a guarantee against a repeat reaction. More research focusing on pathomechanisms, diagnostic testing and premedication is therefore clearly needed in order to prevent CM‐induced hypersensitivity reactions in the future.

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“…Most of them have been conducted during severe skin reactions. In these cases, the affected skin showed perivascular T-cell infiltration, epidermal spongiosis, and necrosis, as well as hydropic degeneration of the basal layer [100,102,121,122,145]. In mild cases, the histological examination showed only a slight lymphocytic perivascular dermal infiltration [51].…”

Section: During or Immediately After The Reactionmentioning

confidence: 99%

“…The dissociation constant corresponded to the intercept of the 2 curves obtained by plotting (1/cpm) in function of the concentration of ICM added (X, mol/L). mechanism are (i) the clinical manifestations of delayed ICM reactions similar to other drug-induced side effects mediated by T-cells [95], (ii) positive patch tests and delayed intradermal tests to the culprit ICM [51,92,[96][97][98], (iii) histological findings of skin showing the presence of infiltrates of T-cells [92,[99][100][101], (iv) in vitro T-cell proliferation with ICM [92], and (v) the reappearance of delayed eruptions after provocation tests [51,102,103]. Fig.…”

Section: T-cell Activationmentioning

confidence: 99%

Hypersensitivity Reactions to Iodinated Contrast Media

Guéant-Rodríguez¹,

Romano²,

Barbaud³

et al. 2006

CPD

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Adverse reactions after iodinate contrast media (ICM) administration have been observed, which can be classified as immediate (i.e., occurring within one hour after administration) and delayed or non-immediate (i.e., occurring more than one hour after administration). Even though the incidence of ICM adverse reactions has been significantly reduced by the introduction of non-ionic compounds, immediate reactions still occur in about 3% of administrations. Different pathogenic mechanisms have been suggested for ICM reactions, including immunologic ones. Basophils and mast cells participate in immediate reactions through the release of mediators like histamine and tryptase, whereas a T-cell-mediated pathogenic mechanism is involved in most non-immediate reactions, particularly maculopapular rashes. Skin tests and specific IgE assays are carried out to diagnose immediate hypersensitivity reactions, while both delayed-reading intradermal tests and patch tests are usually performed to evaluate non-immediate reactions. However, in vitro specific IgE assays are not commercially available. As far as in vitro tests are concerned, a response involving ICM-related T-cell activity may be assessed by the lymphocyte transformation test. Allergologic evaluation appears to be indicated in hypersensitivity reactions to ICM, although the sensitivity, specificity, and predictive values of allergologic tests have not yet been established. This paper summarizes the current state of the art and addresses the research that is still needed on the pathogenic mechanisms, diagnosis, and prevention of ICM-induced hypersensitivity reactions.

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Skin reaction to contrast medium

Cited by 9 publications

References 3 publications

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

Management of hypersensitivity reactions to iodinated contrast media

Hypersensitivity Reactions to Iodinated Contrast Media

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