Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity

María José Torres, Axel Trautmann, Ingrid Böhm, Kathrin Scherer, Annick Barbaud, Sevim Bavbek, Patrizia Bonadonna, Josefina Rodrigues Cernadas, Anca Mirela Chiriac, Francesco Gaeta, Ana M. Gimenez-Arnau, Hye Ryun Kang, Esther Moreno, Knut Brockow

Research output: Contribution to journalArticlepeer-review

91 Scopus citations

Abstract

Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%-3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re-exposition or drug provocation test should only be done with skin test-negative ICMs. The decision for performing either re-exposition or drug provocation test needs to be taken based on a risk-benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial.

Original languageEnglish
Pages (from-to)1325-1339
Number of pages15
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume76
Issue number5
DOIs
StatePublished - May 2021

Keywords

  • IgE
  • Iodinated contrast media
  • T cells
  • allergy
  • diagnosis
  • hypersensitivity
  • management

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