碘在放射对比剂过敏反应中的作用。
The role of iodine in hypersensitivity reactions to radio contrast media.
机构信息
Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
出版信息
Clin Exp Allergy. 2010 Mar;40(3):468-75. doi: 10.1111/j.1365-2222.2009.03361.x.
INTRODUCTION
Hypersensitivity reactions to iodinated radio contrast media (RCM) are either immediate-type (IT) or delayed reactions (DT). In IT, the pathomechanism is unclear. In DT, delayed positive patch (PT) and intradermal tests (IDT) and RCM-specific T cells suggest a T cell-mediated mechanism. In both, the role of iodine has not been clarified; however, patients are often labelled as 'iodine allergic'. Occasionally, positive skin tests to iodine-containing drugs are observed.
OBJECTIVE
We investigated the presence of hypersensitivity to iodine in patients with a history of hypersensitivity reactions to RCM.
METHODS
Nineteen patients with a history of IT (n=9) or DT (n=10) to RCM were investigated. Skin prick tests, IDT and PT with several RCM and iodine formulations were carried out. All underwent oral provocation with Lugol's solution (LS). Two patients each with iodine mumps, contact dermatitis to iodized antiseptics and chronic idiopathic urticaria served as control or proof of concept.
RESULTS
In the IT group, skin tests were positive in three out of nine patients to one RCM. One patient with negative skin tests reacted twice to oral iodine with urticaria. In the DT group, sensitization to one or several RCM was identified in 10 out of 10 patients. In seven out of 10 patients, additional sensitizations to the iodine formulations were found. Two patients developed a mild exanthema after oral provocation with LS.
CONCLUSION
We have previously demonstrated in patients with iodine mumps that an oral challenge with LS is a valid means to elicit hypersensitivity reactions to iodine. In 19 patients, we showed that iodine is rarely the eliciting agent in hypersensitivity reactions to RCM. Only one patient with a late urticaria to an RCM with a late urticaria to LS and two patients with DT and broad sensitization to all RCM tested reacted to LS with an exanthema. In most cases, more likely the RCM molecules and not iodine are the eliciting compounds.
简介
碘造影剂（RCM）引起的超敏反应分为即刻型（IT）和迟发型（DT）。在 IT 中，发病机制尚不清楚。在 DT 中，延迟阳性贴斑（PT）和皮内试验（IDT）以及 RCM 特异性 T 细胞提示 T 细胞介导的机制。在这两种情况下，碘的作用尚未阐明；然而，患者通常被贴上“碘过敏”的标签。偶尔也会观察到对含碘药物的皮肤试验阳性。
目的
我们调查了 RCM 过敏反应史患者对碘过敏的情况。
方法
研究了 19 例 RCM 过敏反应史的患者，包括即刻型（n=9）和迟发型（n=10）。进行了皮肤点刺试验、IDT 和 PT 以及几种 RCM 和碘制剂。所有患者均接受卢戈氏液（LS）口服激发试验。两名患者分别患有碘腮腺炎、含碘消毒剂接触性皮炎和慢性特发性荨麻疹，作为对照或概念验证。
结果
在即刻型组中，9 例患者中有 3 例对 1 种 RCM 的皮肤试验阳性。1 例皮肤试验阴性的患者对口服碘出现两次荨麻疹反应。在迟发型组中，10 例患者中有 10 例对 1 种或多种 RCM 致敏。在 10 例患者中有 7 例发现对碘制剂的额外致敏。2 例患者在口服 LS 后出现轻度皮疹。
结论
我们之前在碘腮腺炎患者中证明，LS 口服激发试验是诱发碘过敏反应的有效方法。在 19 例患者中，我们表明碘很少是 RCM 过敏反应的引发剂。只有 1 例 RCM 迟发性荨麻疹患者对 LS 出现 LS 荨麻疹，2 例迟发型和广泛致敏于所有测试的 RCM 患者对 LS 出现皮疹，对 LS 有反应。在大多数情况下，更有可能是 RCM 分子而不是碘是引发化合物。
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