Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
J Investig Allergol Clin Immunol. 2013;23(3):183-9.
Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed.
We aimed to evaluate the role of controlled challenge testing in skin test-positive IHR to ICM.
We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test-negative ICM; a further 2 patients underwent computed tomography with an alternative skin test-negative ICM. No premedication was administered.
Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test-negative ICM. The 2 patients who underwent computed tomography with an alternative skin test-negative ICM tolerated the medium.
Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test-positive reactions in order to identify an alternative non-cross-reactive ICM.
碘造影剂（ICM）引起的即刻超敏反应（IHR）传统上被认为是非过敏的；然而，越来越多的阳性皮肤试验和嗜碱性粒细胞活化试验结果提示在一些患者中存在特定的过敏机制。皮肤试验已被提议作为一种有用的诊断工具，尽管其敏感性和预测值仍有待确定。受控挑战测试的作用尚未评估。
我们旨在评估受控挑战测试在皮肤试验阳性的 ICM 引起的 IHR 中的作用。
我们通过对引起反应的药物进行皮肤试验评估了 106 例 ICM 引起的 IHR 患者。选择皮肤试验阳性的患者。皮肤试验扩展至一系列 8 种 ICM；5 例患者接受了另一种皮肤试验阴性的 ICM 的受控挑战测试；另外 2 例患者接受了另一种皮肤试验阴性的 ICM 的计算机断层扫描。未给予预用药。
106 例患者中，11 例（10.4%）对引起反应的 ICM 进行皮内试验结果阳性。在这 11 例患者中，有 5 例患者耐受了另一种皮肤试验阴性的 ICM 的受控挑战测试。接受另一种皮肤试验阴性的 ICM 计算机断层扫描的 2 例患者耐受了造影剂。
皮肤试验对诊断 ICM 引起的过敏 IHR 患者很有用。由于在许多患者中，由于 ICM 在某些诊断或治疗技术中不可替代，因此无法避免使用 ICM，因此应研究替代的安全 ICM 用于未来的程序。我们建议根据皮肤试验结果使用受控挑战测试来解决皮肤试验阳性反应中的这一需求，以识别替代的非交叉反应性 ICM。
