Service de Radiologie Générale Adultes, Hôpital de Bicêtre, Secteur Paul Broca, 78, rue du Générale Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France.
Eur Radiol. 2011 Nov;21(11):2305-10. doi: 10.1007/s00330-011-2200-9. Epub 2011 Jul 16.
Late adverse reactions (LAR) to contrast media (CM) are defined as reactions occurring 1 h to 1 week after exposure.
In view of more prospective studies of LAR and new data about their pathophysiology, the Contrast Medium Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) reviewed the literature on LAR and updated their guidelines.
LAR after CM include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. Skin reactions are well-documented LAR to CM with an incidence of approximately 2%-4% after nonionic monomers. LAR are commoner by a factor of three to four after nonionic dimers. The commonest skin reactions are maculopapular rashes, erythema and skin swelling. These reactions are T cell-mediated immune reactions, and the diagnosis may be confirmed using skin tests (patch or delayed reading intradermal). The main risk factors for LAR are a previous reaction to contrast medium, a history of allergy, and interleukin-2 treatment. Most skin reactions are mild or moderate and self-limiting.
Management is symptomatic and similar to the management of other drug-induced skin reactions. To reduce the risk of repeat reactions avoidance of the relevant CM and any cross-reacting agents identified by skin testing is recommended.
对比剂（CM）的迟发不良反应（LAR）被定义为在接触后 1 小时至 1 周内发生的反应。
鉴于对 LAR 的更多前瞻性研究以及关于其病理生理学的新数据，欧洲泌尿生殖放射学会（ESUR）的对比剂安全委员会（CMSC）审查了关于 LAR 的文献，并更新了他们的指南。
CM 后 LAR 包括恶心、呕吐、头痛、瘙痒、皮疹、肌肉骨骼疼痛和发热等症状。皮肤反应是 CM 发生 LAR 的良好记录，在使用非离子单体后，其发生率约为 2%-4%。非离子二聚体后 LAR 更为常见，其发生率增加三到四倍。最常见的皮肤反应是斑丘疹、红斑和皮肤肿胀。这些反应是 T 细胞介导的免疫反应，可使用皮肤试验（斑贴或延迟皮内读数）来确诊。LAR 的主要危险因素是对对比剂的先前反应、过敏史和白细胞介素-2 治疗。大多数皮肤反应为轻度或中度，且具有自限性。
管理是对症治疗，与其他药物引起的皮肤反应的管理相似。为了降低重复反应的风险，建议避免使用相关的 CM 和通过皮肤试验确定的任何交叉反应剂。
