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
Department of Dermatology und Allergology Biederstein, Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM, Technical University Munich, Munich, Germany.
Allergy. 2009 Feb;64(2):234-41. 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.
碘化造影剂可引起速发型和非速发型超敏反应。这项前瞻性研究的目的是确定经历过此类反应的患者皮肤试验的特异性和敏感性。
对220例有速发型或非速发型反应的患者进行了一系列造影剂的皮肤点刺、皮内和斑贴试验。根据国际公认的指南定义阳性皮肤试验。71例从未接触过造影剂的受试者和11例耐受造影剂接触的受试者作为阴性对照。
皮肤试验特异性为96%-100%。对于在反应后2至6个月内进行的试验，高达50%的速发型反应者和高达47%的非速发型反应者皮肤试验呈阳性。对于速发型反应者，皮内试验最敏感，而对于非速发型反应者，延迟皮内试验与斑贴试验联合使用可获得最佳敏感性。造影剂交叉反应在非速发型组比速发型组更常见。有趣的是，49%的速发型症状和52%的非速发型症状发生在既往未接触过造影剂的患者中。这些患者中有许多皮肤试验呈阳性，表明他们在首次接触造影剂时就已经致敏。
这些数据表明，至少50%的造影剂超敏反应是由免疫机制引起的。皮肤试验似乎是诊断造影剂过敏的有用工具，并且可能在为既往有反应的患者选择安全产品中发挥重要作用。
