[Anaphylactoid reactions and late skin reactions to iodinated contrast media: present state of the question--idea development].
OBJECTIVE
Adverse reactions to iodinated contrast media (ICM) share various mechanisms. Anaphylactoid reactions are among the most serious reactions when they are characterized by the elevation of seric tryptase. Pretreatment with corticosteroids and anti-H1 or the use of non-ionic contrast media do not prevent anaphylaxis. Late skin reactions could be mostly related to delayed hypersensitivity. Previous reactions to contrast media, cardiovascular disorders, beta-blockers, asthma, and atopy are risk factors. Female gender and age increase the severity.


BACKGROUND
Anaphylaxis can be demonstrated by intradermal tests and the identification of specific IgEs. Delayed hypersensitivity is shown by the results of epicutaneous tests and the immunohistology of the skin.


CONCLUSIONS
Allergologic tests are advised in the case of previous reactions. In case of emergency, gadopentetate dimeglumine can be alternatively used. The other risk factors lead to the combination of pretreatment and use of non-ionic monomeric contrast media. Immediate hypersensitivity to iodinated media might increase in the near future with the use of divalent molecules.
Moneret-Vautrin
D A
DA
Service de médecine interne, immunologie clinique et allergologie, hôpital Central, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France. a.moneret-vautrin@chu-nancy.fr
Kanny
G
G
Morisset
M
M
Beaudouin
E
E
Renaudin
J M
JM
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000707:Anaphylaxis / Q000209:etiology*; D003287:Contrast Media / Q000009:adverse effects*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D017613:Iodine Compounds / Q000009:adverse effects*; D012307:Risk Factors; D012871:Skin Diseases / Q000139:chemically induced*
D000305:Adrenal Cortex Hormones; D003287:Contrast Media; D006634:Histamine H1 Antagonists; D017613:Iodine Compounds; D007073:Immunoglobulin E