PMID- 18287437
OWN - NLM
STAT- MEDLINE
DCOM- 20080410
LR  - 20220408
IS  - 1546-3141 (Electronic)
IS  - 0361-803X (Linking)
VI  - 190
IP  - 3
DP  - 2008 Mar
TI  - Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or 
      IgE-mediated allergy?
PG  - 666-70
LID - 10.2214/AJR.07.2872 [doi]
AB  - OBJECTIVE: Contrast material is generally well tolerated although approximately 
      1% of patients who receive low-osmolar nonionic contrast material will develop 
      anaphylaxis symptoms. Because most anaphylactic reactions are mild and 
      nonallergic, clinically mimicking immunoglobulin E (IgE)-mediated allergy, 
      diagnostic skin testing has been discussed controversially in the past and 
      prophylactic pretreatment drug regimens are recommended instead. In the past 6 
      years, all patients with contrast material-induced anaphylaxis have been 
      subjected to allergologic diagnostic procedures to clearly differentiate allergic 
      and nonallergic anaphylaxis. Thus the purpose of our study was to identify and 
      differentiate IgE-mediated allergy and nonallergic contrast material-induced 
      hypersensitivity. Furthermore, the objective of our diagnostic procedures was not 
      only to identify the culprit contrast material but also to find alternative 
      contrast material for future radiologic interventions. SUBJECTS AND METHODS: We 
      evaluated 96 patients with anaphylaxis symptoms after contrast material 
      application using standardized intradermal skin testing. In patients with 
      positive skin tests, the IgE-mediated allergy was further evaluated with in vitro 
      and challenge tests. RESULTS: In four patients (suffering from anaphylaxis grades 
      2 and 3) out of the 96 (4.2%), skin tests and basophil activation tests strongly 
      suggested IgE-mediated allergy to the contrast materials iopromide (two 
      patients), iomeprol, and iopentol. In two patients with allergies to iopromide 
      and iomeprol, alternative nonionic monomer contrast materials were tolerated, as 
      identified in controlled challenge tests with iopamidol and iopromide, 
      respectively. CONCLUSION: The evaluation of patients with contrast 
      material-induced anaphylaxis (at least those with anaphylaxis > or = grade 2) 
      should always include appropriate skin tests ensuring that patients with an 
      IgE-mediated allergy are not missed. Moreover, allergologic testing may identify 
      a contrast material of the group of nonionic monomers that will be tolerated in 
      future radiologic interventions.
FAU - Trcka, Jiri
AU  - Trcka J
AD  - Department of Dermatology and Venerology, University of Rostock, Rostock, 
      Germany.
FAU - Schmidt, Claudia
AU  - Schmidt C
FAU - Seitz, Cornelia S
AU  - Seitz CS
FAU - Brocker, Eva-B
AU  - Brocker EB
FAU - Gross, Gerd E
AU  - Gross GE
FAU - Trautmann, Axel
AU  - Trautmann A
LA  - eng
PT  - Journal Article
PL  - United States
TA  - AJR Am J Roentgenol
JT  - AJR. American journal of roentgenology
JID - 7708173
RN  - 0 (Contrast Media)
RN  - 0 (Triiodobenzoic Acids)
RN  - 17E17JBP8L (iomeprol)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - 4419T9MX03 (Iohexol)
RN  - 712BAC33MZ (iopromide)
RN  - 7D6XWX076T (iopentol)
RN  - JR13W81H44 (Iopamidol)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anaphylaxis/chemically induced/*diagnosis/immunology
MH  - Basophil Degranulation Test
MH  - Cohort Studies
MH  - Contrast Media/*adverse effects
MH  - Diagnostic Imaging
MH  - Female
MH  - Halogenation
MH  - Humans
MH  - Immunoglobulin E/*physiology
MH  - Iohexol/adverse effects/analogs & derivatives
MH  - Iopamidol/adverse effects/analogs & derivatives
MH  - Male
MH  - Middle Aged
MH  - Skin Tests
MH  - Triiodobenzoic Acids/adverse effects
EDAT- 2008/02/22 09:00
MHDA- 2008/04/11 09:00
CRDT- 2008/02/22 09:00
PHST- 2008/02/22 09:00 [pubmed]
PHST- 2008/04/11 09:00 [medline]
PHST- 2008/02/22 09:00 [entrez]
AID - 190/3/666 [pii]
AID - 10.2214/AJR.07.2872 [doi]
PST - ppublish
SO  - AJR Am J Roentgenol. 2008 Mar;190(3):666-70. doi: 10.2214/AJR.07.2872.