Clement Olivier, Dewachter Pascale, Mouton-Faivre Claudie, Nevoret Camille, Guilloux Laurence, Bloch Morot Evelyne, Katsahian Sandrine, Laroche Dominique, Audebert Martine, Benabes-Jezraoui Béatrice, Benoit Yves, Beot Sylvie, Berard Frédéric, Berthezene Yves, Bertrand Philippe, Bouffard Juliette, Bourrain Jean-Luc, Boyer Bruno, Carette Marie-France, Caron-Poitreau Christine, Cavestri Béatrice, Cercueil Jean Pierre, Charpin Denis-André, Collet Evelyne, Crombe-Ternamian Arielle, Dalmas Jacques, Decoux Eric, Defrance Marie-France, Delaval Yvonne, Demoly Pascal, Depriester Claude, Depriester Pascale, Didier Alain, Drouet Martine, Dupas Benoît, Dupre-Goetchebeur Dominique, Dzviga Charles, Fabre Christine, Ferretti Gilbert, Fourre-Jullian Corinne, Girardin Pascal, Giron Jacques, Gouitaa Marion, Grenier Nicolas, Guenard Bilbault Lydie, Guez Stéphane, Gunera-Saad Nathalie, Heautot Jean-François, Herbin Dominique, Hoarau Cyrille, Jacquot Claude, Julien Christian, Laborie Laurent, Lambert Claude, Larroche Pascal, Leclerc Xavier, Lemaitre Laurent, Leynadier Francisque, Lillo-Le-Louet Agnès, Louvel Jean-Pierre, Louvier Nathalie, Lucas Marie-Madeleine, Meites Geneviève, Mennesson Nicolas, Metge Liliane, Meunier Yannick, Monnier-Cholley Laurence, Musacchio Mariano, Nicolie Brigitte, Occelli Gisèle, Oesterle Hélène, Paisant-Thouveny Francine, Panuel Michel, Railhac Nadine, Rety-Jacob Frédérique, Rochefort-Morel Cécile, Roy Catherine, Sarlieve Philippe, Sesay Musa, Sgro Catherine, Taourel Patrice, Terrier Patrick, Theissen Odile, Topenot Ingrid, Valfrey Jocelyne, Veillon Francis, Vergnaud Marie-Claude, Veyret Charles, Vincent Denis, Wallaert Benoit, Wessel François, Zins Marc
Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France.
Inserm U970 Université Paris Descartes Sorbonne Paris Cité, Laboratoire Imagerie 56 rue Leblanc Paris, FR 75015, France.
EClinicalMedicine. 2018 Jul 28;1:51-61. doi: 10.1016/j.eclinm.2018.07.002. eCollection 2018 Jul.
Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.
Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.
Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups.
Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.
含碘和钆的造影剂（ICM；GBCM）可引发速发型超敏反应（IH）。区分过敏性与非过敏性IH至关重要；过敏意味着终生禁用该致病剂。我们研究了ICM或GBCM反应者中过敏性IH的发生率。
2005年至2009年间在31家医院招募患者。记录临床症状、血浆组胺和类胰蛋白酶浓度以及皮肤试验情况。通过将致病造影剂稀释1:10进行皮内试验（IDT）诊断过敏性IH，通过使用纯造影剂的阳性IDT诊断“潜在过敏性”IH，通过阴性IDT诊断非过敏性IH。
在245例接受皮肤试验的患者中（ICM = 209例；GBCM = 36例），41例（19.6%）被确定为对ICM发生过敏性IH，10例（27.8%）对GBCM发生过敏性IH。11例ICM患者（26.8%）和5例GBCM患者（50%）观察到皮肤交叉反应。过敏发生率随临床严重程度以及组胺和类胰蛋白酶浓度增加而升高（p < 0.0001）。心血管体征与过敏密切相关。152例患者（62%）（ICM：134例；GBCM：18例）观察到非过敏性IH。严重程度分级较低（p < 0.0001），反应延迟较长（11.6分钟对5.6分钟；p < 0.001）。42例患者（17.1%）（ICM：34例；GBCM：8例）被诊断为潜在过敏性IH。延迟时间、严重程度分级和介质释放介于其他两组之间。
过敏性IH占皮肤反应的比例不到10%，但占危及生命反应的比例超过50%。GBCM和ICM引发的IH反应在频率和严重程度上相当。交叉反应很常见，尤其是对于GBCM。我们建议考虑使用纯造影剂进行皮肤试验，因为它比通常的1:10稀释标准更敏感。
Zotero 插件
