From the Division of Allergy and Clinical Immunology, Department of Internal Medicine (S.K.), and Department of Radiology (J.L.), School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (K.N.J.); Department of Radiology, Gyeonsang National University Changwon Hospital, Changwon, Republic of Korea (K.N.J.); Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea (J.W.J.); Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea (H.K.P.); Departments of Radiology (W.L.) and Internal Medicine (H.R.K.), Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea (H.R.K.).
Radiology. 2023 Oct;309(1):e222467. doi: 10.1148/radiol.222467.
Background The recurrence of hypersensitivity reaction (HSR) to low-osmolar iodinated contrast media (LOCM) remains challenging despite premedication and substitution of the LOCM. Purpose To determine the optimal practical preventive strategy for LOCM substitution in patients with a history of prior immediate HSR to LOCM. Materials and Methods In a retrospective study, patients with an immediate HSR to LOCM before February 2020 and who underwent subsequent exposure to LOCM until March 2021 were enrolled in five tertiary referral hospitals in South Korea. The association of recurrence of an HSR after subsequent LOCM exposures was assessed using multivariate general estimating equation analysis according to age, sex, the severity of the index HSR, premedication, and substituting LOCM based on common carbamoyl side chains, including the -(2,3-dihydroxypropyl)-carbamoyl and -(2,3-dihydroxypropyl)--methyl-carbamoyl moieties. Results The evaluation included 3800 subsequent LOCM exposures in 1066 patients (mean age, 56.2 years ± 13.5 [SD]; 567 [53%] female and 499 [47%] male patients). The general estimating equation analysis, using 1:1 propensity score matched data for age, sex, HSR severity, and LOCM selection, showed that premedication with corticosteroids significantly reduced recurrent HSR (odds ratio [OR], 0.72; 95% CI: 0.52, 1.00; = .049). The change to another LOCM with a common side chain had a similar recurrence rate as using the same LOCM (OR, 0.98; 95% CI: 0.64, 1.50; = .93), whereas the use of a different LOCM without a common side chain significantly lowered HSR recurrence (OR, 0.51; 95% CI: 0.37, 0.69; < .001) in multivariate general estimating equation analysis. Substitution of an LOCM without a common side chain was effective regardless of the index HSR severity but was more pronounced in moderate-to-severe reactions (OR, 0.30; 95% CI: 0.16, 0.55; < .001). Conclusion For patients with a previous immediate HSR of any severity to LOCM, alternative LOCM without a common carbamoyl side chain reduced recurrent HSR during subsequent exposures. © RSNA, 2023 See also the editorial by McDonald in this issue.
尽管进行了预处理和低渗碘造影剂（LOCM）的替代，过敏反应（HSR）的复发仍然具有挑战性。
确定既往对 LOCM 即刻 HSR 患者进行 LOCM 替代的最佳实用预防策略。
在这项回顾性研究中，纳入了 2020 年 2 月前因 LOCM 发生即刻 HSR 且在 2021 年 3 月前接受后续 LOCM 暴露的患者，这些患者来自韩国的五家三级转诊医院。根据年龄、性别、指数 HSR 的严重程度、预处理和基于常见氨甲酰侧链（包括-(2,3-二羟丙基）-氨甲酰基和-(2,3-二羟丙基）-甲基氨甲酰基）替代 LOCM，使用多变量一般估计方程分析评估随后的 LOCM 暴露后 HSR 复发的相关性。
该评估纳入了 1066 例患者的 3800 次后续 LOCM 暴露（平均年龄，56.2 岁±13.5[标准差]；567[53%]为女性，499[47%]为男性）。使用年龄、性别、HSR 严重程度和 LOCM 选择的 1:1 倾向评分匹配数据的一般估计方程分析显示，皮质类固醇预处理可显著降低 HSR 复发（比值比，0.72；95%置信区间：0.52，1.00； =.049）。使用具有常见侧链的另一种 LOCM 与使用相同 LOCM 的复发率相似（比值比，0.98；95%置信区间：0.64，1.50； =.93），而使用无常见侧链的不同 LOCM 可显著降低 HSR 复发（比值比，0.51；95%置信区间：0.37，0.69；<.001）。在多变量一般估计方程分析中，无论指数 HSR 严重程度如何，替代无常见侧链的 LOCM 均有效，但在中重度反应中更为明显（比值比，0.30；95%置信区间：0.16，0.55；<.001）。
对于既往有任何严重程度对 LOCM 即刻 HSR 的患者，替代无常见氨甲酰侧链的 LOCM 可降低后续暴露时的 HSR 复发。
