The incidence of skin lesions in contrast media-induced chemical hypersensitivity

Abstract

Contrast agents are used in radiology to increase the sensibility and specificity of radiological techniques. Some of these compounds have side effects that include organ toxicity (with kidney being the most affected organ) and hypersensitivity reactions. We performed multiple PubMed searches from January, 2008 to January, 2018 for studies regarding adverse reactions to compounds used as contrast agents in imagistic techniques. The initial research identified 929 records written in English. After further excluding 223 non-human studies, 292 articles that had irrelevant designs as reviews, meta-analysis, commentaries, editorials and case reports, 414 studies were selected for retrieval. After reading the abstracts, we excluded 363 studies as they had little relevance to the study. In total, 51 full-articles were assessed for eligible studies to be included. Finally, 20 articles were included in the analysis. In our systematic literature search the incidence of overall skin immediate reactions to iodinated contrast media (ICM) had an incidence between 1.15 and 0.12%, depending on the cohort analyzed in the studies. The percentage of cutaneous manifestations in the cohort that experienced immediate hypersensitivity reactions was between 33.33 and 87.7%. The most frequent skin manifestations were urticaria, rashes, pruritus and limited facial edema. Non-iodinated contrast agents have a safer profile compared with ICM, the incidence of immediate adverse reactions being very low in gadolinium-based contrast agents and other agents used for contrast-enhanced ultrasound. The incidence of delayed reactions was between 10.1 and 0.03%. In the studies analyzed by us the main adverse reactions due to delayed hypersensitivity phenomena were cutaneous manifestations that were present between 70.27 and 100% of the cases. Regarding the risk factors for developing immediate adverse reactions, being female was a predisposing factor accompanied by history of allergy and history of reactions to contrast media. An accurate anamnesis of the patients and a correctly conducted pretreatment can limit the incidence and the severity of the adverse reactions and also can avoid the life occurrence of life-threatening reactions.

Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches

“…Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an iatrogenic acute kidney injury (AKI) observed after intravascular administration of contrast media (CM) for diagnostic procedures or therapeutic angiographic interventions [ 1 – 4 ]. Chemical hypersensitivity has also been reported as another side effect of CM [ 5 ]. According to the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines for AKI, a serum creatinine (Cr) increase of at least 0.3 mg/dL (or 26.5 µmol/L) over the baseline value within 48 h after exposure to CM, or an increase greater than 1.5 times over the baseline value within 7 days after exposure to CM, or a urinary volume of less than 0.5 mL/kg/h for at least 6 h after exposure, are the definition of this condition [ 6 ].…”

Renoprotective effects of stevia (Stevia rebaudiana Bertoni), amlodipine, valsartan, and losartan in gentamycin-induced nephrotoxicity in the rat model: Biochemical, hematological and histological approaches

“…Extract of Indian gooseberry leaves demonstrated antioxidant and renoprotective effect in cisplatin-induced nephrotoxicity [8]. Moreover, contrast media-induced organ toxicity specially nephrotoxicity is one of the major concerns nowadays [6,9]. Again, natural products with antioxidant and free radical scavenging ability have the potential benefiacial effect in the prevention and treatment of organ toxicity.…”

“…In last two decades, various parameters of aminoglycoside-induced nephrotoxicity have been researched [21]. Reactive oxygen species (ROS) play the leading role in nephrotoxicity caused by the extensive accumulations of gentamycin in the kidney tissue [9,10,15]. Again, gentamycin increased intracellular calcium concentration causing mesengial cell contraction, in turn, can induce the renin-angiotensin system, resulting in the formation of many vasoconstrictor substances like angiotensin II, endothelin I, and thromboxane A 2 [10,15,16].…”

[Editorial] The Second Conference of the Romanian Society of Immuno‑Dermatology, Bucharest, September 27-29, 2018

“…Adverse drug reactions were reported by Iordache et al (20), which showed the incidence and different aspects of skin lesions in contrast-induced chemical hypersensitivity.…”