Grueber Hans-Peter, Helbling Arthur, Joerg Lukas
Radiology Division, Spital Region Oberaargau, Spital Langenthal, Langenthal, Switzerland.
Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Allergy Asthma Immunol Res. 2021 Nov;13(6):933-938. doi: 10.4168/aair.2021.13.6.933.
Allergies to gadolinium-based contrast agents (GBCAs) are rare and manifest usually as an immediate drug hypersensitivity reaction (DHR), compatible with an immunoglobulin E (IgE)-mediated mechanism. Although the molecular structures of GBCA show some similarities and are either linear or macrocyclic, the frequency and pattern of cross-reactivity remain unclear. However, cross-reactivity has been described. The aim of this investigation was to assess cross-reactivity in patients with GBCA allergy based on skin tests and exposure. We retrospectively evaluated a total of 28 cases with a proven allergy to a GBCA, including 11 from the database of the allergy division of the Inselspital, Bern and 17 published cases from the literature, retrieved with a PubMed-MEDLINE search. The majority of cases were immediate DHR, with 8/11 cases from the database (72.7%) and 16/17 published cases (94.1%). In both groups macrocyclic GBCA were most often identified as causative drugs. A cross-reactivity based on skin test results was found in 2 out of 11 database cases (18.2%) and in 6 out of 17 literature cases (35.3%). Cross-reactivity occurred within macrocyclic GBCA in 1/11 database cases and 3/17 literature cases, and included both macrocyclic and linear GBCA in 1/11 and 4/17 subjects. There was no cross sensitization among linear GBCA. Skin test-negative GBCA were well tolerated, even in cases with sensitization to linear and macrocyclic GBCA. Overall, cross-reactivity in GBCA allergy is rare (approximately 29%), and may occur among macrocyclic GBCA or in between macrocyclic and linear GBCA. IgE to linear GBCA seems to be rarely cross-reactive. Skin test is helpful in identifying safe alternatives, as no reaction to skin test-negative GBCA was observed.
对钆基造影剂（GBCA）的过敏反应很少见，通常表现为即时药物过敏反应（DHR），符合免疫球蛋白E（IgE）介导的机制。尽管GBCA的分子结构显示出一些相似性，且要么是线性的，要么是大环的，但交叉反应的频率和模式仍不清楚。然而，已有交叉反应的描述。本研究的目的是基于皮肤试验和暴露情况评估GBCA过敏患者的交叉反应。我们回顾性评估了总共28例经证实对GBCA过敏的病例，其中11例来自伯尔尼因塞尔医院过敏科数据库，17例为从PubMed-MEDLINE检索到的文献中发表的病例。大多数病例为即时DHR，数据库中的8/11例（72.7%）和发表病例中的16/17例（94.1%）。在两组中，大环GBCA最常被确定为致病药物。11例数据库病例中有2例（18.2%）、17例文献病例中有6例（35.3%）发现基于皮肤试验结果的交叉反应。1/11例数据库病例和3/17例文献病例中，交叉反应发生在大环GBCA之间，1/11和4/17例受试者中交叉反应包括大环和线性GBCA。线性GBCA之间没有交叉致敏。皮肤试验阴性的GBCA耐受性良好，即使在对线性和大环GBCA致敏的病例中也是如此。总体而言，GBCA过敏中的交叉反应很少见（约29%），可能发生在大环GBCA之间或大环与线性GBCA之间。针对线性GBCA的IgE似乎很少发生交叉反应。皮肤试验有助于确定安全的替代方案，因为未观察到对皮肤试验阴性的GBCA有反应。
