Tolerability of Gadobenate Dimeglumine in a Patient With Reported Allergy to Gadoterate Meglumine

Moulin, Clelia; Saïd, B. Ben; Berard, F.

doi:10.2214/ajr.10.4372

Cited by 12 publications

(16 citation statements)

References 4 publications

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“…Heterogeneity between studies was low. one with gadoterate, one with an unknown GBCA) and underwent repeat GBCA administration (13,15,(25)(26)(27). Four underwent allergy skin testing prior to subsequent GBCA administration; of these, one patient was premedicated with corticosteroids and three were not.…”

Section: Comparison Of the Number And Proportion Of Breakthrough Reactionsmentioning

confidence: 99%

Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis

et al. 2020

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EVIDENCE-BASED PRACTICEG adolinium-based contrast agents (GBCAs) have been used clinically for decades and have an excellent safety record (1-3). Immediate hypersensitivity reactions to GB-CAs remain uncommon, estimated by meta-analysis to be approximately nine per 10 000 administrations, with severe reactions occurring in approximately five per 100 000 administrations (4). Limited studies have evaluated repeat GBCA administration in patients with a prior hypersensitivity reaction to a GBCA. The efficacy of corticosteroid premedication with or without antihistamines prior to repeat GBCA exposure remains unproven. Although commonly performed in clinical practice, the rationale for premedication prior to repeat GBCA administration is extrapolated from studies evaluating iodinated contrast media (5). Breakthrough reactions are immediate hypersensitivity reactions occurring despite appropriately dosed corticosteroid premedication. These reactions occur in up to one-third of patients in individual series that have studied GBCAs (6-8). Breakthrough reactions to GBCAs usually occur with the same severity as the original or index reaction, but escalation of breakthrough reaction severity to a GBCA has been reported (6-8). In patients with a prior severe hypersensitivity reaction to a GBCA, re-exposure to a GBCA (even with corticosteroid premedication) is contraindicated by the American College of Radiology (ACR) (9).

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Section: Comparison Of the Number And Proportion Of Breakthrough Reactionsmentioning

confidence: 99%

Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis

et al. 2020

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“…In the case of IHR with positive skin tests, a provocation was performed with an alternative gadolinium-based contrast medium and a negative skin test: all provocations were negative. 35 – 38 …”

Section: Resultsmentioning

confidence: 99%

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

Bansie

Karim

Maaren

et al. 2021

Int J Immunopathol Pharmacol

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Introduction: Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. Methods: A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. Results: Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. Conclusion: In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

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“…Accordingly, none of our patients had positive SPTs with GBCAs. Other reported cases [1,7,8,9,10,11] had positive SPTs with GBCAs. Nonetheless, most cases diagnosed by STs, are by IDTs.…”

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confidence: 94%

“…GBCA immediate reactions are infrequent, with isolated case reports or very short J Investig Allergol Clin Immunol 2021; Vol. 31 (6) © 2021 Esmon Publicidad doi: 10.18176/jiaci.0694 series published [1,3,[5][6][7][8][9][10]. Hasdenteufel et al [8] reported two anaphylactic shocks with GM.…”

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confidence: 99%

“…31 (6) © 2021 Esmon Publicidad doi: 10.18176/jiaci.0694 cross-reactivities more frequent between GM and gadobutrol, both macrocyclic, although they described three patients monosensitized to gadobutrol. Moulin et al [10] reported an anaphylactic reaction to GM with a strongly positive SPT with gadoterate and negative STs to four GBCAs, linear and macrocyclic. They performed a DPT with gadobenate dimeglumine with good tolerance.…”

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confidence: 99%

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Patterns of Cross-Reactivity in Patients With Immediate Hypersensitivity Reactions to Gadobutrol

Gallardo-Higueras¹,

Moreno²,

Muñoz-Bellido³

et al. 2021

J Investig Allergol Clin Immunol

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Tolerability of Gadobenate Dimeglumine in a Patient With Reported Allergy to Gadoterate Meglumine

Cited by 12 publications

References 4 publications

Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis

Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis

Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

Patterns of Cross-Reactivity in Patients With Immediate Hypersensitivity Reactions to Gadobutrol

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