Laboratory of Clinical Immunology, Department of Microbiology and Clinical Immunology, KU Leuven, Leuven, Belgium; Exploration des Allergies, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.
Laboratory of Clinical Immunology, Department of Microbiology and Clinical Immunology, KU Leuven, Leuven, Belgium.
J Allergy Clin Immunol Pract. 2018 Jul-Aug;6(4):1246-1254. doi: 10.1016/j.jaip.2017.10.040. Epub 2018 Jan 19.
The management of iodinated contrast medium (ICM) hypersensitivity has been a matter of debate. Skin testing to identify a subgroup of ICM allergic patients has been proposed, in addition to complete avoidance, provocation testing, or premedication.
The objective of this study was to assess the negative predictive value (NPV) of skin testing for ICM.
Patients with a hypersensitivity reaction to ICM who underwent skin testing during a 13.5-year period at a single center were evaluated for re-exposure to a negatively skin-tested ICM. Premedication, consisting of second-generation H1-antihistamines twice a day 48 hours before the examination, was advised only for patients with mast cell disorder or chronic urticaria who had negative skin tests.
A total of 597 patients tested for 423 (70.9%) immediate, 118 (19.7%) nonimmediate, and 56 (9.4%) hypersensitivity reactions with undetermined chronology were included. Eighty (13.4%) patients were skin test positive. Re-exposure to ICM occurred in 233 (39.0%) patients and was tolerated in 16 of 17 (94.1%) with at least 1 positive skin test and 201 of 216 (93.1%) with all negative skin tests. Reaction intensity was similar in 4, milder in 10, unknown in 1, and worse in 1 patient although this reaction was deemed to be nonallergic in hindsight. Premedication was administered in 20.7% of patients and associated with more reactions (19.4% vs 5.7%, P = .01). The overall NPV of skin testing for ICM was 93.1% (95% confidence interval [CI] 89.1% to 96.0%), and for immediate and nonimmediate hypersensitivity reactions 94.2% (95% CI 89.6% to 97.2%) and 86.1% (95% CI 72.1% to 94.7%), respectively. We cannot exclude some challenges occurred with a different than the initial culprit ICM, possibly overestimating the NPV.
Skin testing for potential ICM hypersensitivity can identify safe alternative(s) for ICM re-exposure especially in patients with an immediate hypersensitivity reaction and/or skin test-proven ICM drug allergy. Reactions on re-exposure were infrequent, mostly milder, and occurred in some patients despite premedication.
碘造影剂（ICM）过敏的管理一直存在争议。除了完全避免、激发试验或预先用药外，还提出了皮肤试验来识别 ICM 过敏患者的亚组。
本研究旨在评估 ICM 皮肤试验的阴性预测值（NPV）。
在一家中心的 13.5 年期间，对发生 ICM 过敏反应的患者进行皮肤试验，评估对经皮肤试验阴性的 ICM 重新暴露的情况。建议仅对有肥大细胞紊乱或慢性荨麻疹且皮肤试验阴性的患者，在检查前 48 小时，每日两次服用第二代 H1 抗组胺药进行预先用药。
共纳入 597 例患者，其中 423 例（70.9%）为即刻反应，118 例（19.7%）为非即刻反应，56 例（9.4%）为反应时间不确定的过敏反应。80 例（13.4%）患者皮肤试验阳性。233 例（39.0%）患者重新接触 ICM，其中 17 例至少 1 次皮肤试验阳性的患者中有 16 例（94.1%）可耐受，216 例所有皮肤试验阴性的患者中有 201 例（93.1%）可耐受。4 例患者的反应强度相似，10 例患者的反应较轻，1 例患者反应情况未知，1 例患者的反应更严重，尽管事后认为该反应为非过敏反应。20.7%的患者接受了预先用药，反应更多（19.4%比 5.7%，P=0.01）。皮肤试验对 ICM 的总体 NPV 为 93.1%（95%置信区间 [CI] 89.1%至 96.0%），即刻和非即刻过敏反应的 NPV 分别为 94.2%（95% CI 89.6%至 97.2%）和 86.1%（95% CI 72.1%至 94.7%）。我们不能排除用不同于初始致敏 ICM 的药物进行再暴露时出现一些挑战的可能性，这可能会高估 NPV。
皮肤试验可用于潜在的 ICM 过敏反应，确定 ICM 重新暴露的安全替代药物，尤其是在发生即刻过敏反应和/或经皮肤试验证实的 ICM 药物过敏的患者中。再次接触时的反应很少见，大多较轻微，尽管预先用药，仍有一些患者发生反应。
