Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Ann Allergy Asthma Immunol. 2013 Apr;110(4):258-62. doi: 10.1016/j.anai.2013.01.004. Epub 2013 Feb 4.
Some radiocontrast media (RCM) hypersensitivity reactions may have underlying IgE- or T-cell-mediated mechanisms. RCM skin testing may be useful for predicting future reactions.
To investigate the clinical value of RCM skin testing before computed tomography and after RCM hypersensitivity reactions.
Patients who underwent RCM skin testing were a prospective sample of convenience at a single medical center and were tested just before their pending nonionic RCM-enhanced computed tomogram. In addition, skin test data of patients who were referred to the allergy clinic because of their previous RCM hypersensitivity reactions were reviewed retrospectively.
A total of 1048 patients enrolled in the study prospectively. Of these, 672 (64.1%) had never been exposed to RCM. Of the 376 previously exposed to RCM, 61 (16.2%) had a history of at least one mild RCM-associated reaction, 56 (91.8%) had immediate reactions, and 5 had no-immediate reactions. There was only 1 positive immediate hypersensitivity RCM skin test result (0.09%). There were 51 mild immediate reactions (4.9%), 1 moderate immediate reaction (0.09%), 8 mild nonimmediate reactions (0.76%), and 1 moderate nonimmediate reaction (0.09%). There was only 1 positive delayed hypersensitivity skin test result (0.09%), retrospectively determined, in 1 (11.1%) of the nonimmediate RCM-associated reactions. Sensitivity of RCM skin testing was significantly higher with severe immediate reactions (57.1%) than mild reactions (12.9%) and moderate reactions (25.0%) in the retrospective review of diagnostic skin test data (P = .03).
RCM skin testing for screening is of no clinical utility in predicting hypersensitivity reactions. RCM skin testing may have modest utility in retrospectively evaluating severe adverse reactions.
一些造影剂（RCM）过敏反应可能存在 IgE 或 T 细胞介导的机制。RCM 皮肤试验可能有助于预测未来的反应。
探讨 RCM 皮肤试验在 CT 前和 RCM 过敏反应后的临床价值。
在一家医疗中心，前瞻性选择接受 RCM 皮肤试验的患者作为方便样本，在他们即将进行的非离子型 RCM 增强 CT 前进行检测。此外，回顾性分析因 RCM 过敏反应而转诊至过敏科的患者的皮肤试验数据。
共纳入 1048 例前瞻性研究患者。其中 672 例（64.1%）从未接触过 RCM。在 376 例既往接触过 RCM 的患者中，61 例（16.2%）有至少 1 次轻度 RCM 相关反应史，56 例（91.8%）有即刻反应，5 例无即刻反应。仅有 1 例即刻过敏反应 RCM 皮肤试验阳性结果（0.09%）。有 51 例轻度即刻反应（4.9%）、1 例中度即刻反应（0.09%）、8 例轻度迟发反应（0.76%）和 1 例中度迟发反应（0.09%）。在对非即刻 RCM 相关反应的回顾性诊断性皮肤试验数据中，仅有 1 例（11.1%）迟发反应呈阳性（0.09%）。在回顾性分析中，严重即刻反应（57.1%）的 RCM 皮肤试验敏感性明显高于轻度反应（12.9%）和中度反应（25.0%）（P=0.03）。
RCM 皮肤试验筛查对于预测过敏反应无临床应用价值。RCM 皮肤试验在回顾性评估严重不良反应方面可能具有一定的作用。
