Skin Tests for the Exploration of Hypersensitivity Reactions Associated with Iodinated Contrast Media

Abstract

Background: Iodinated contrast media (ICM) are responsible for multiple side effects, especially hypersensitivity reactions. These reactions can either be authentic allergies, or non-allergic hypersensitivity reactions. Skin tests (prick and intradermal tests) are simple to perform and can be of great help, especially if the ICM need to be re-used. The aim of the study was to assess the characteristics of the patients in whom skin tests were performed, and the results of these tests. Methods: This is a retrospective study from June 2014 to June 2019. All included patients had at least one episode of hypersensitivity reaction to ICM and underwent skin tests. Results : We included 35 patients aged 18 to 85 years. The iopromide was the most implicated ICM. The reactions were mainly cutaneous (n=30) and immediate (n=27). The skin tests were negative, except for two patients. The reuse of ICM occured in 11 patients: 9 with an ICM other than the one suspected and two patients with the same ICM. Among these patients, 5 did not have any premedication. Two of them had a second hypersensitivity reaction, the first with another ICM and the second with the same ICM. Conclusion: One of the main pillars of allergic exploration is ICM skin testing, not only to prevent recurrence, but also to allow patients to benefit from ICM reuse, which are sometimes essential.

Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging

“…3,11 Current literature recommends the use of skin testing for ICM immediate hypersensitivity reactions to prevent recurrence of adverse reactions; allow patients to benefit from ICM reuse that are sometimes essential; and identify safe alternatives for future radiologic investigations. 5,14 Complete evaluation includes skin-prick test and intradermal testing to check for IgE-mediated reactions followed by drug provocation testing when skin testing is negative. 5 Our allergists adopted this approach in assessing patients with ICM reactions, where either the initial reaction was disproved, or an alternative ICM was identified via negative skin testing and drug contrast allergy.…”