Kalogeromitros Dimitrios C, Makris Michael P, Aggelides Xenophon S, Spanoudaki Nektaria, Gregoriou Stamatios G, Avgerinou Georgia, Rigopoulos Dimitrios G
Allergy Unit, Attikon Hospital, University of Athens, Athens, Greece.
Int Arch Allergy Immunol. 2007;144(2):150-4. doi: 10.1159/000103227. Epub 2007 May 25.
Gadolinium chelates are relatively safe contrast media used in MRI. Immediate severe adverse effects are exceptionally rare and mostly concern mild anaphylactoid reactions. We report a case of anaphylaxis to gadobenate dimeglumine (Gd-BOPTA, Multihance), a gadolinium-based contrast agent.
A 32-year-old female patient with a personal history of multiple sclerosis, while undergoing an MRI scan, developed bronchospasm and acute urticaria with diffuse giant pruritic plaques in the first minute of Gd-BOPTA infusion. The procedure was cancelled and acute treatment of the reaction took place. The patient reported 2 additional MRI scans with definite use of unknown contrast media in the past 2 years without any adverse effect. Blood samples were obtained 2 and 48 h after the reaction for measurement of serum tryptase concentration (Pharmacia Diagnostics, Uppsala, Sweden). Skin prick tests and intradermal tests were performed using 1:1,000, 1:100 and 1:10 dilution of the offending agent and alternative gadolinium-based agents [gadodiamide (Omniscan) and gadoteric acid (Dotarem)]. A group of 10 nonatopic individuals who underwent the same skin testing comprised the control group.
Tryptase concentration was highly elevated 2 h after the reaction (21 microg/l) compared with that at 48 h (3 microg/l). Skin prick tests in our patient were all negative, while intradermal testing with 0.03 ml of 1:100 and 1:10 preparations of Multihance showed a definite positive wheal-and-flare reaction. Skin tests to the alternative agents showed no response. In the control group, all performed tests were negative.
We report the first case of an allergic reaction to gadobenate dimeglumine. Besides, skin testing seems to be a precious diagnostic tool which, if positive, strongly suggests a mast cell-mediated underlying mechanism.
钆螯合物是磁共振成像（MRI）中使用的相对安全的造影剂。即刻严重不良反应极为罕见，主要涉及轻度类过敏反应。我们报告一例对钆贝葡胺（Gd - BOPTA，Multihance），一种钆基造影剂的过敏反应病例。
一名有多发性硬化症个人病史的32岁女性患者，在进行MRI扫描时，在输注Gd - BOPTA的第一分钟出现支气管痉挛、急性荨麻疹并伴有弥漫性巨大瘙痒性斑块。该检查被取消，并对反应进行了紧急治疗。患者报告在过去两年中另外进行了2次MRI扫描，明确使用了未知造影剂，未出现任何不良反应。在反应发生后2小时和48小时采集血样，用于测定血清类胰蛋白酶浓度（Pharmacia Diagnostics，瑞典乌普萨拉）。使用致敏剂和替代钆基造影剂[钆喷酸葡胺（Omniscan）和钆特酸（Dotarem）]的1:1000、1:100和1:10稀释液进行皮肤点刺试验和皮内试验。一组10名接受相同皮肤试验的非特应性个体组成对照组。
与48小时时（3μg/l）相比，反应后2小时类胰蛋白酶浓度显著升高（21μg/l）。我们患者的皮肤点刺试验均为阴性，而用0.03 ml的1:100和1:10的Multihance制剂进行皮内试验显示有明确的阳性风团和红晕反应。对替代造影剂的皮肤试验无反应。在对照组中，所有进行的试验均为阴性。
我们报告了首例对钆贝葡胺过敏反应的病例。此外，皮肤试验似乎是一种宝贵的诊断工具，如果呈阳性，则强烈提示存在肥大细胞介导的潜在机制。
