Immediate and delayed cutaneous reactions to radiocontrast media

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

41 Scopus citations

Abstract

Hypersensitivity reactions to contrast media (CM) are frequent causes of anaphylaxis and drug exanthemas. Adverse events after CM exposure are classified into immediate (>1 h) and non-immediate reactions (>1 h), with differing mechanisms. In the majority of patients with immediate reactions, IgE-mediated allergy cannot be demonstrated, and the underlying mechanism remains unknown. However, recent data have provided evidence for skin test positivity and/or specific IgE in some patients. T cell-mediated hypersensitivity is the responsible mechanism for the majority of non-immediate skin eruptions. These insights have consequences for diagnosis and prevention. Skin testing evolves to be a useful tool for diagnosis of CM allergy. Skin tests have been employed to confirm this hypersensitivity. Previous reactors have an increased risk to develop new reactions upon repeated exposure; however, other risk factors are poorly defined. The use of skin tests for the selection of a 'safe' CM is under investigation with promising results. In vitro tests to search for CM-specific cell activation include flow cytometric approaches, lymphocyte cultures and construction of cell lines and hybridomas. Premedication of previous reactors is common practice among radiologists; however, breakthrough reactions are a concern, and physicians should not rely on the efficacy of pharmacological premedication.

Original languageEnglish
Title of host publicationAdverse Cutaneous Drug Eruptions
EditorsLars French
Pages180-190
Number of pages11
DOIs
StatePublished - May 2012

Publication series

NameChemical Immunology and Allergy
Volume97
ISSN (Print)1660-2242
ISSN (Electronic)1662-2898

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