Edited by: Hans-Uwe Simon
Diagnostic evaluation of patients with nonimmediate cutaneous hypersensitivity reactions to iodinated contrast media
Article first published online: 15 MAY 2012
© 2012 John Wiley & Sons A/S
Volume 67, Issue 7, pages 929–935, July 2012
How to Cite
To cite this article: Torres MJ, Gomez F, Doña I, Rosado A, Mayorga C, Garcia I, Blanca-Lopez N, Canto G, Blanca M. Diagnostic evaluation of patients with nonimmediate cutaneous hypersensitivity reactions to iodinated contrast media. Allergy 2012; DOI:10.1111/j.1398-9995.2012.02840.x.
- Issue published online: 8 JUN 2012
- Article first published online: 15 MAY 2012
- Manuscript Accepted: 3 APR 2012
- Junta de Andalucía. Grant Number: PI04888/2009
- FIS-Thematic Networks and Co-operative Research Centres:. Grant Number: RIRAAF
- drug provocation test;
- Iodinated contrast media;
- skin tests
Nonimmediate hypersensitivity reactions to iodinated contrast media (CM) are common. Allergological evaluation is necessary to confirm the diagnosis and to find a tolerated alternative. The aim of this study was to establish the role of skin testing and the drug provocation test (DPT) in the diagnosis of nonimmediate reactions to CM.
Skin intradermal testing and patch testing with delayed readings were carried out with different CM (iobitridol, iomeprol, iodixanol, iohexol, ioversol, iopramide and ioxaglate). Single-blind placebo-controlled DPT was carried out in those cases with a negative skin test. In seven cases, a skin biopsy was obtained from positive skin tests and positive DPT.
Of the 161 subjects evaluated, 34 (21.1%) were skin-test positive, 21 (50%) to Iomeprol, 7 (16.7%) to Iodixanol, 5 (11.9%) to Iobitridol, 4 (9.5%) to Ioxaglate, 3 (7.1%) to Iohexol and 1 (2.4%) to Iopramide. DPT was positive in 44 cases (34.6%) that were skin-test negative, 38 (76%) to Iodixanol, 8 (16%) to Iomeprol and 4 (8%) to Iohexol. Of 78 cases (48.4%) with confirmed hypersensitivity, 34 (43.6%) were identified by skin testing and 44 (56.4%) by DPT. Skin biopsies showed a perivascular mononuclear cell infiltrate, mainly in the dermis, with higher levels of CD4 than CD8 T lymphocytes, with expression of activation markers and skin homing receptors.
Patients with nonimmediate reactions to CM were identified by skin testing in 43.6% and by DPT in 56.4%. The method to confirm the diagnosis differed depending on the CM involved.