Hypersensitivity reactions to iodinated contrast media.
Adverse reactions after iodinate contrast media (ICM) administration have been observed, which can be classified as immediate (i.e., occurring within one hour after administration) and delayed or non-immediate (i.e., occurring more than one hour after administration). Even though the incidence of ICM adverse reactions has been significantly reduced by the introduction of non-ionic compounds, immediate reactions still occur in about 3% of administrations. Different pathogenic mechanisms have been suggested for ICM reactions, including immunologic ones. Basophils and mast cells participate in immediate reactions through the release of mediators like histamine and tryptase, whereas a T-cell-mediated pathogenic mechanism is involved in most non-immediate reactions, particularly maculopapular rashes. Skin tests and specific IgE assays are carried out to diagnose immediate hypersensitivity reactions, while both delayed-reading intradermal tests and patch tests are usually performed to evaluate non-immediate reactions. However, in vitro specific IgE assays are not commercially available. As far as in vitro tests are concerned, a response involving ICM-related T-cell activity may be assessed by the lymphocyte transformation test. Allergologic evaluation appears to be indicated in hypersensitivity reactions to ICM, although the sensitivity, specificity, and predictive values of allergologic tests have not yet been established. This paper summarizes the current state of the art and addresses the research that is still needed on the pathogenic mechanisms, diagnosis, and prevention of ICM-induced hypersensitivity reactions.
Guéant-Rodriguez
Rosa-Maria
RM
INSERM U-724, Laboratory of Cellular and Molecular Pathology in Nutrition, Faculty of Medicine, B.P. 184 - 54505 Vandoeuvre-les-Nancy Cedex, France. rm.rodriguez@chu-nancy.fr
Romano
Antonino
A
Barbaud
Annick
A
Brockow
Knut
K
Guéant
Jean-Louis
JL
D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D017613:Iodine Compounds / Q000009:adverse effects* / Q000737:chemistry
D003287:Contrast Media; D017613:Iodine Compounds