title: Immediate hypersensitivity to iodinated contrast media: diagnostic accuracy of skin tests and intravenous provocation test with low dose.
abstract: BACKGROUND
  The diagnosis of HSR to iodinated contrast media (ICM) is challenging based on clinical history and skin tests.
  
  
  OBJECTIVE
  This study evaluates the negative predictive value (NPV) of skin tests and intravenous provocation test (IPT) with low-dose ICM in patients with suspected immediate hypersensitivity reaction (HSR) to ICM.
  
  
  METHODS
  Thirty-seven patients with suspected immediate hypersensitivity reaction to ICM were included retrospectively. Skin tests and a single-blind placebo-controlled intravenous provocation test (IPT) with low-dose iodinated contrast media (ICM) were performed.
  
  
  RESULTS
  Skin tests with ICM were positive in five cases (one skin prick test and five intradermal test). Thirty-six patients were challenged successfully by IPT, and only one patient had a positive challenge result, with a grade I reaction by the Ring and Messmer classification. Ten of 23 patients followed up by telephone were re-exposed to a negative tested ICM during radiologic examination; two experienced a grade I immediate reaction.
  
  
  CONCLUSIONS
  For immediate hypersensitivity reaction to ICM, the NPV for skin tests and IPT with low dose was 80% (95% CI 44-97%).
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Sesé
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Gaouar
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.
authors.forename: J-E
authors.initials: JE
authors.lastname: Autegarden
authors.affiliation: Inserm UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, Paris, France.|Institut Pasteur, UMR 1181, B2PHI, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Alari
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Amsler
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Vial-Dupuy
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Pecquet
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.|Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), UPMC Univ Paris 06, Sorbonne Universités, Paris, France.|Institut National de Santé et de Recherche Médicale (INSERM) U1135, Cimi-Paris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Francès
authors.affiliation: Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.|Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), UPMC Univ Paris 06, Sorbonne Universités, Paris, France.|Institut National de Santé et de Recherche Médicale (INSERM) U1135, Cimi-Paris, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Soria
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000209:etiology*; D017613:Iodine Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012882:Skin Tests
chemical_list: D003287:Contrast Media; D017613:Iodine Compounds
keywords: hypersensitivity reaction; intravenous provocation tests; iodinated contrast media; skin tests