Skin testing in patients with hypersensitivity reactions to iodinated contrast media - a European multicenter study

• Published in: Allergy Vol. 64; no. 2; pp. 234 - 241
• Main Authors: Brockow, K, Romano, A, Aberer, W, Bircher, A.J, Barbaud, A, Bonadonna, P, Faria, E, Kanny, G, Lerch, M, Pichler, W.J, Ring, J, Rodrigues Cernadas, J, Tomaz, E, Demoly, P, Christiansen, C
• Format: Journal Article
• Language: English
• Published: Oxford, UK Oxford, UK : Blackwell Publishing Ltd 01.02.2009; Blackwell Publishing Ltd; Blackwell
• Subjects: Adolescent; Adult; adverse effects; Aged; Aged, 80 and over; Allergies; Biological and medical sciences; Child; Contrast Media; Contrast Media - adverse effects; Cross Reactions; Cross Reactions - immunology; diagnosis; Diagnostic tests; diagnostic use; Drug Hypersensitivity; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug Hypersensitivity - immunology; etiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; hypersensitivity; Immunology; Iodine; Iodine - adverse effects; Iodine - immunology; Male; Medical imaging; Medical sciences; Middle Aged; Prospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sensitivity and Specificity; Skin; Skin Tests; Young Adult; Europe; Human; skin tests; Immunopathology; Immunology; Dermatology; Multicenter study; Hypersensitivity; Exploration; Radioopaque marker; Contrast media; Iodine; Skin test
• ISSN: 0105-4538; 1398-9995; 1398-9995; 0108-1675
• DOI: 10.1111/j.1398-9995.2008.01832.x

Iodinated contrast media cause both immediate and nonimmediate hypersensitivity reactions. The aim of this prospective study was to determine the specificity and sensitivity of skin tests in patients who have experienced such reactions. Skin prick, intradermal and patch tests with a series of contrast media were conducted in 220 patients with either immediate or nonimmediate reaction. Positive skin tests were defined according to internationally accepted guidelines. Seventy-one never-exposed subjects and 11 subjects who had tolerated contrast medium exposure, served as negative controls. Skin test specificity was 96-100%. For tests conducted within the time period from 2 to 6 months after the reaction, up to 50% of immediate reactors and up to 47% of nonimmediate reactors were skin test positive. For immediate reactors, the intradermal tests were the most sensitive, whereas delayed intradermal tests in combination with patch tests were needed for optimal sensitivity in nonimmediate reactors. Contrast medium cross-reactivity was more common in the nonimmediate than in the immediate group. Interestingly, 49% of immediate and 52% of nonimmediate symptoms occurred in previously unexposed patients. Many of these patients were skin test positive, indicating that they were already sensitized at the time of first contrast medium exposure. These data suggest that at least 50% of hypersensitivity reactions to contrast media are caused by an immunological mechanism. Skin testing appears to be a useful tool for diagnosis of contrast medium allergy and may play an important role in selection of a safe product in previous reactors.