Nonimmediate hypersensitivity reactions to iodinated contrast media

Purpose of reviewTo provide a detailed analysis of the latest findings on the mechanisms underlying the nonimmediate reactions to iodinated contrast media and comment on the recent advances in diagnosis, focusing on the roles of the skin test, drug provocation test (DPT), and lymphocyte transformation test (LTT). Recent findingsSeveral studies have reported new findings supporting an important role for T-lymphocytes in the nonimmediate reactions to iodinated contrast media. The LTT has been used as an in-vitro tool for diagnosis, but with variable results. However, the inclusion of autologous monocyte-derived dendritic cells as professional antigen-presenting cells has improved the sensitivity of this test. Regarding in-vivo diagnosis, although skin testing has been routine, it has now been shown that its sensitivity and negative predictive value are low. Recent studies have demonstrated that the DPT is a well tolerated and useful procedure that is necessary to confirm the diagnosis of nonimmediate hypersensitivity reactions to iodinated contrast media. SummaryNonimmediate reactions to contrast media are usually T-cell mediated. Diagnosis is based on skin testing, although its sensitivity and negative predictive value are not optimal. Consequently, drug provocation testing is often needed to confirm the diagnosis and also to seek alternative contrast media that can be tolerated.

[1]  E. Moreno,et al.  Selection of contrast media in patients with delayed reactions should be based on challenge test results. , 2012, The Journal of allergy and clinical immunology.

[2]  M. Blanca,et al.  Diagnostic evaluation of patients with nonimmediate cutaneous hypersensitivity reactions to iodinated contrast media , 2012, Allergy.

[3]  Y. Jee,et al.  A Clinical Study of Cutaneous Adverse Reactions to Nonionic Contrast Media in Korea , 2012, Annals of dermatology.

[4]  L. Heinzerling,et al.  Is drug allergy less prevalent than previously assumed? A 5‐year analysis , 2012, The British journal of dermatology.

[5]  M. Morisset,et al.  Delayed hypersensitivity reactions caused by iodixanol: an assessment of cross-reactivity in 22 patients. , 2011, The Journal of allergy and clinical immunology.

[6]  D. Muñoz,et al.  Fixed drug eruption caused by iodinated contrast media , 2011, Contact dermatitis.

[7]  M. Blanca,et al.  Recognition of iodixanol by dendritic cells increases the cellular response in delayed allergic reactions to contrast media , 2011, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[8]  S. Akyar,et al.  Hypersensitivity Reactions to Contrast Media: Prevalence, Risk Factors and the Role of Skin Tests in Diagnosis – A Cross-Sectional Survey , 2011, International Archives of Allergy and Immunology.

[9]  N. Poliak,et al.  Acute generalized exanthematous pustulosis: the first pediatric case caused by a contrast agent. , 2010, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[10]  Chin-Shang Li,et al.  Delayed adverse reaction to contrast-enhanced CT: a prospective single-center study comparison to control group without enhancement. , 2010, Radiology.

[11]  P. Bousquet,et al.  Clinical value of negative skin tests to iodinated contrast media , 2010, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[12]  M. Blanca,et al.  Specific immunological response to budesonide in a patient with delayed-type hypersensitivity reaction. , 2010, The Journal of investigative dermatology.

[13]  E. Bröcker,et al.  Radiocontrast media-associated exanthema: identification of cross-reactivity and tolerability by allergologic testing. , 2009, European journal of radiology.

[14]  K. Brockow.  Immediate and delayed reactions to radiocontrast media: is there an allergic mechanism? , 2009, Immunology and allergy clinics of North America.

[15]  J. Callen,et al.  Ioversol-induced acute generalized exanthematous pustulosis: a case report. , 2009, Archives of dermatology.

[16]  A Romano,et al.  Skin testing in patients with hypersensitivity reactions to iodinated contrast media – a European multicenter study , 2009, Allergy.

[17]  M. Torres,et al.  Lymphocyte proliferation response in patients with delayed hypersensitivity reactions to heparins , 2009, The British journal of dermatology.

[18]  G. Angelini,et al.  Occupational allergic contact dermatitis to a non‐ionic iodinated contrast medium containing iomeprol , 2008, Contact dermatitis.

[19]  J. Ellis,et al.  Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. , 2008, AJR. American journal of roentgenology.

[20]  P. Kam,et al.  Intravascular iodinated contrast media and the anaesthetist , 2008, Anaesthesia.

[21]  C. Rondón,et al.  Monitoring non‐immediate allergic reactions to iodine contrast media , 2008, Clinical and experimental immunology.

[22]  A. Vannacci,et al.  Safety aspects of iodinated contrast media related to their physicochemical properties: a pharmacoepidemiology study in two Tuscany hospitals , 2008, European Journal of Clinical Pharmacology.

[23]  M. Blanca,et al.  Differential cytokine and transcription factor expression in patients with allergic reactions to drugs , 2007, Allergy.

[24]  M. Britschgi,et al.  Cross-reactivity patterns of T cells specific for iodinated contrast media. , 2007, The Journal of allergy and clinical immunology.

[25]  S. Pérez-Gala,et al.  Late skin reaction to iodixanol (Visipaque®): clinical manifestations, patch test study, and histopathological evaluation , 2006, Contact dermatitis.

[26]  P. Demoly,et al.  Diagnosis of iodinated contrast media hypersensitivity: results of a 6‐year period , 2006, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[27]  R. Katzberg,et al.  Acute generalized exanthematous pustulosis as a delayed dermatotoxic reaction to IV-administered nonionic contrast media. , 2006, AJR. American journal of roentgenology.

[28]  H. I. Maibach,et al.  Drug eruptions to contrast media in Japan , 2006, Clincal and Experimental Dermatology.

[29]  Anthony Delaney,et al.  The prevention of anaphylactoid reactions to iodinated radiological contrast media: a systematic review , 2006, BMC Medical Imaging.

[30]  C. Christiansen,et al.  X-ray contrast media--an overview. , 2005, Toxicology.

[31]  Enda,et al.  Management of hypersensitivity reactions to iodinated contrast media , 2005, Allergy.

[32]  A. Barbaud,et al.  Low negative predictive value of skin tests in investigating delayed reactions to radio‐contrast media , 2004, Contact dermatitis.

[33]  D. Hohl,et al.  Severe Stevens–Johnson syndrome induced by contrast medium iopentol (Imagopaque®) , 2004, The British journal of dermatology.

[34]  Y. Itai,et al.  Reversed double PCL sign: unusual location of a meniscal fragment of the knee observed by MR imaging , 2003, European Radiology.

[35]  M. Britschgi,et al.  Non‐covalent presentation of sulfamethoxazole to human CD4+ T cells is independent of distinct human leucocyte antigen‐bound peptides , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[36]  R. Pettinato,et al.  Effective prophylactic protocol in delayed hypersensitivity to contrast media: report of a case involving lymphocyte transformation studies with different compounds. , 2002, Radiology.

[37]  W. Pichler,et al.  Macular exanthema appearing 5 days after X-ray contrast medium administration , 2002, European Radiology.

[38]  J. Ring,et al.  Late skin test reactions to radiocontrast medium. , 1999, The Journal of allergy and clinical immunology.

[39]  A. Bircher,et al.  Delayed‐type hypersensitivity to a nonionic, radiopaque contrast medium , 1998, Allergy.

[40]  Raija Mikkonen.  Incidence and risk factors for delayed allergy‐like reactions to X‐ray contrast media in adult and pediatric populations , 1998, Pharmacoepidemiology and drug safety.

[41]  E. Macher,et al.  STUDIES ON THE SENSITIZATION OF ANIMALS WITH SIMPLE CHEMICAL COMPOUNDS. II , 1936, The Journal of experimental medicine.

[42]  C. Rondón,et al.  Drug hypersensitivity reactions: response patterns, drug involved, and temporal variations in a large series of patients. , 2012, Journal of investigational allergology & clinical immunology.

[43]  M. Blanca,et al.  T cell assessment in allergic drug reactions during the acute phase according to the time of occurrence. , 2006, International journal of immunopathology and pharmacology.

[44]  D. Moneret-vautrin,et al.  T cell-mediated reactions to iodinated contrast media: evaluation by skin and lymphocyte activation tests. , 2005, The Journal of allergy and clinical immunology.

[45]  H. Thomsen,et al.  Late adverse reactions to intravascular iodinated contrast media , 2002, European Radiology.

[46]  G. Cantó,et al.  Toxic epidermal necrolysis after repeated injections of iohexol. , 2001, AJR. American journal of roentgenology.

[47]  R. Nilsson,et al.  Immunologic basis for adverse reactions to radiographic contrast media. , 1990, Acta radiologica.