评估皮肤试验和激发试验引起的即刻和非即刻超敏反应：综述。
Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review.
机构信息
Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.
Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname.
出版信息
Int J Immunopathol Pharmacol. 2021 Jan-Dec;35:20587384211015061. doi: 10.1177/20587384211015061.
INTRODUCTION
Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice.
METHODS
A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM.
RESULTS
Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%-9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%-34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM.
CONCLUSION
In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.
简介
碘对比剂（ICM）和钆基对比剂的过敏和非过敏超敏反应分别归类为即刻或非即刻超敏反应（IHR 和 NIHR）。皮肤试验和激发试验被推荐用于评估对比剂的超敏反应；然而，在临床实践中并不常见。
方法
对调查 ICM 皮肤试验和激发试验的研究进行了 MEDLINE 搜索。
结果
确定了 19 项报告 ICM 皮肤试验和激发试验的研究。在 ICM 的 IHR 中，69 例（94%）对可疑介质皮肤试验阳性的患者可耐受皮肤试验阴性的替代 ICM 挑战。在 ICM 的 IHR 中，对可疑介质皮肤试验阴性的患者，激发试验阳性率为 3.2%-9.1%。在 ICM 的 NIHR 中，皮肤试验阳性患者用皮肤试验阴性药物激发可耐受 75/105（71%）例。在 NIHR 中，对可疑药物皮肤试验阴性的患者，再次接触可疑药物或替代药物阳性率为 0%-34.6%。在 IHR 或 NIHR 皮肤试验阳性患者中，用相同的 ICM 进行激发试验，大多数患者为阳性，但此类激发试验很少进行。关于钆基对比剂的超敏反应、皮肤试验和激发试验的数据有限；然而，它们表现出与 ICM 观察到的相似模式。
结论
在 ICM 和钆基对比剂中，皮肤试验阴性时，即刻重复反应的风险较低。相反，用皮肤试验阳性的对比剂激发显示出即刻重复超敏反应的高风险。因此，在诊断不确定时，需要进行详细的病史回顾，并进行皮肤试验。建议进行激发试验以进行诊断评估。
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