title: Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis.
abstract: BACKGROUND
  Patients with a previous history of hypersensitivity reaction (HSR) to iodinated contrast media (ICM) are at high risk of the development of HSR to ICM. Many studies have tried to evaluate the diagnostic potential of skin tests in this population but have not yet reached a common conclusion. We investigated the role of skin tests in patients with HSR to ICM in terms of positive rate, cross-reactivity rate, and tolerability to skin test-negative ICM according to the type of HSR.
  
  
  METHODS
  We performed literature searches of the MEDLINE and EMBASE databases and included studies where skin tests were performed in patients with HSR to ICM, with extractable outcomes. Outcomes were pooled using a random-effects model.
  
  
  RESULTS
  Twenty-one studies were included. Pooled per-patient positive rates of skin tests were 17% (95% CI, 10-26%) in patients with immediate HSR, and up to 52% (95% CI, 31-72%) when confined to severe immediate HSR. Among patients with nonimmediate HSR, the positive rate was 26% (95% CI, 15-41%). The pooled per-patient cross-reactivity rate was higher in nonimmediate HSR (68%; 95% CI, 48-83%) than that in immediate HSR (39%; 95% CI, 29-50%). Median per-test cross-reactivity rates between pairs of ICM were 7% (IQR, 6-9%) in immediate HSR and 38% (IQR, 22-51%) in nonimmediate HSR. Pooled per-patient recurrence rates of HSR to skin test-negative ICM were 7% (95% CI, 4-14%) in immediate HSR and 35% (95% CI, 19-55%) in nonimmediate HSR.
  
  
  CONCLUSIONS
  Skin tests may be helpful in diagnosing and managing patients with HSR to ICM, especially in patients with severe immediate HSR.
authors: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
authors: S H
authors: SH
authors: Yoon
authors: Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors: S-Y
authors: SY
authors: Lee
authors: Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: H-R
authors: HR
authors: Kang
authors: Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: J-Y
authors: JY
authors: Kim
authors: Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: S
authors: S
authors: Hahn
authors: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.|Cancer Research Institute, Seoul National University, Seoul, Korea.
authors: C M
authors: CM
authors: Park
authors: Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors: Y-S
authors: YS
authors: Chang
authors: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.|Cancer Research Institute, Seoul National University, Seoul, Korea.
authors: J M
authors: JM
authors: Goo
authors: Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: S-H
authors: SH
authors: Cho
mesh_terms: D003287:Contrast Media / Q000009:adverse effects*; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000175:diagnosis*; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000175:diagnosis*; D017613:Iodine Compounds / Q000009:adverse effects*; D012882:Skin Tests
chemical_list: D003287:Contrast Media; D017613:Iodine Compounds
keywords: contrast media; hypersensitivity; meta-analysis; skin test; systematic review