Allergy Unit, Regional University Hospital of Malaga-IBIMA-UMA-ARADyAL, Malaga, Spain.
Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
Allergy. 2021 May;76(5):1325-1339. doi: 10.1111/all.14656.
Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%-3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re-exposition or drug provocation test should only be done with skin test-negative ICMs. The decision for performing either re-exposition or drug provocation test needs to be taken based on a risk-benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial.
碘造影剂（ICM）的即刻和迟发性超敏反应据报道在接受非离子型 ICM 的患者中的发生率约为 0.5%-3%。这些患者的诊断和管理因不同国家和国际科学协会发布的指南而异，建议范围从避免或预先用药到药物激发试验。本立场文件旨在为 ICM 超敏反应患者的管理提供建议，并分析该领域的争议。皮试被推荐作为诊断即刻和迟发性超敏反应患者的初始步骤；此外，它们还可以帮助指导替代药物的耐受性。仅对 ICM 皮试阴性的患者进行再暴露或药物激发试验。是否进行再暴露或药物激发试验的决定需要基于风险效益分析。体外试验在诊断和预防反应中的作用仍存在争议。
