Clinical value of radiocontrast media skin tests as a prescreening and diagnostic tool in hypersensitivity reactions

ABSTRACT Objective: Controversies continue over the diagnostic approach, prediction, and premedication in radiocontrast media (RCM) hypersensitivity. One of the most important problems encountered in daily clinical practice is that patients do not recall which contrast agent has been used in previous exposures. Also, in most cases, the details of the reaction have not been recorded. Therefore, difficulties are experienced in decision-making about skin testing and premedication in patients who are suspected of RCM hypersensitivity. To assess the clinical value of skin tests and premedication in RCM hypersensitivity. Materials and Methods: A retrospective evaluation was made of the medical records of patients between October 2014 and December 2019. The skin tests were performed with the culprit agent if it was known, otherwise, with iohexol, one of the most commonly used RCM in Turkey. As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed. Results: A total of 41 patients were evaluated (32 females and 9 males). Of the reactions, 35 (85.4%) were immediate and 6 (14.6%) were non-immediate. Three (7.3%) had a positive intradermal test result. It was determined that 20 patients (17 immediate, 3 non- immediate), required imaging with RCM again. Of these, 18 received premedication and two did not, although it was recommended. Of the patients who received premedication, one (5.5%) had an urticarial reaction of the same grade, while both patients (100%) who did not receive premedication developed an immediate allergic reaction that was of a similar grade to that of the previous reaction. Conclusion: Skin test positivity for RCM was observed at low rates. In cases with negative skin tests and when the culprit drug cannot be identified, re-exposure to alternative RCM under premedication may reduce the risk of the reaction. Keywords: Allergy, iodinated contrast media, iobitridol, iohexol, premedication

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Early Biomarkers for Severe Drug Hypersensitivity Reactions

Current Pharmaceutical Design ◽

10.2174/1381612825666191107105440 ◽

2019 ◽

Vol 25 (36) ◽

pp. 3829-3839 ◽

Cited By ~ 1

Author(s):

Adriana Ariza ◽

Maria J. Torres ◽

Carmen Moreno-Aguilar ◽

Rubén Fernández-Santamaría ◽

Tahia D. Fernández

Keyword(s):

Drug Exposure ◽

Drug Hypersensitivity ◽

Clinical Manifestations ◽

Skin Tests ◽

Time Interval ◽

Hypersensitivity Reactions ◽

Early Biomarkers ◽

Immunological Mechanisms ◽

Drug Hypersensitivity Reactions ◽

Delayed Reactions

Drug hypersensitivity reactions (DHRs) are typically classified into immediate and delayed reactions based on the time interval between drug exposure and onset of symptoms. Clinical manifestations range from mild to severe and life-threatening reactions. The most severe clinical entities are anaphylaxis and anaphylactic shock for immediate reactions, and severe cutaneous adverse reactions such as Steven Johnson Syndrome and Toxic Epidermal Necrolysis for delayed reactions. The diagnosis is complex and challenging, as drug provocation tests and even skin tests can be very risky procedures, which makes them not recommended. Therefore, it is necessary to search for useful early biomarkers to manage the diagnosis of these reactions. These biomarkers could be useful to determine the clinical entity, but not to identify the culprit drug. Some of the currently available biomarkers are few genetic associations of drug allergy with polymorphisms of human leukocyte antigen (HLA), the detection of inflammatory and lipid mediators in serum, or the detection of cytokines, chemokines, and cytotoxic markers in skin biopsies. In this literature review, it has been summarize the immunological mechanisms involved in severe reactions, both immediate and delayed, and different early biomarkers: those currently used for the diagnosis of these reactions as well as possible early biomarkers that could be useful with further studies to standardize their clinical use.

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Impact of an electronic consultant system on hypersensitivity reactions to iodinated radiocontrast media: an observational study

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2013-132538 ◽

2015 ◽

Vol 91 (1074) ◽

pp. 193-199 ◽

Cited By ~ 5

Author(s):

Min-Suk Yang ◽

Sang-Il Choi ◽

Woo-Jung Song ◽

Sae-Hoon Kim ◽

Hye-Ryun Kang ◽

...

Keyword(s):

Observational Study ◽

Hypersensitivity Reactions ◽

Radiocontrast Media

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In Vivo Cysteinyl Leukotriene Release in Allergic and Nonallergic Immediate Hypersensitivity Reactions during Anesthesia

Anesthesiology ◽

10.1097/aln.0000000000001600 ◽

2017 ◽

Vol 126 (5) ◽

pp. 834-841 ◽

Cited By ~ 2

Author(s):

Dominique Laroche ◽

Pierre Léturgie ◽

Delphine Mariotte ◽

Yann Ollivier ◽

Jean-Luc Hanouz ◽

...

Keyword(s):

Mast Cell ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Immediate Hypersensitivity ◽

Mast Cell Tryptase ◽

Cysteinyl Leukotriene ◽

Negative Results ◽

Important Mediator ◽

The Difference

Abstract Background Immediate hypersensitivity reactions occurring during anesthesia are classified as allergic when skin tests and mast cell tryptase are positive and as nonallergic when negative results are obtained. Cysteinyl leukotrienes (cysLTs) are potent mediators synthesized by mast cell and eosinophil that induce bronchial constriction. They could play a role in hypersensitivity reactions. Methods cysLT C4, D4, and E4 concentrations were measured by a competition immunoassay in serial plasma samples obtained prospectively from 21 anesthetized controls and retrospectively from 34 patients who reacted at induction of anesthesia (24 with allergic and 10 with nonallergic reactions). Results In controls, the median (interquartile range) cysLT concentration was 0.83 (0.69 to 1.02) μg/l before anesthesia and was unchanged 30 min, 6 h, and 24 h afterward. In the patients with allergic reactions, the values were highly increased 30 to 60 min after the reaction (17.9 [7.8 to 36.0] μg/l), while the patients with nonallergic reactions had less increased values (7.3 [3.0 to 11.5] μg/l). The difference between the three groups was significant (P < 0.0001). Increased values persisted during the 24 h of observation. Concentrations were significantly higher in patients with bronchospasm (P = 0.016). Conclusions cysLTs appear to be an important mediator of allergic and nonallergic immediate hypersensitivity reactions. These findings might open a new field for management of patients with hypersensitivity reactions, especially nonallergic ones.

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Hypersensitivity Reactions Associated with Platinum Antineoplastic Agents: A Systematic Review

Metal-Based Drugs ◽

10.1155/2010/207084 ◽

2010 ◽

Vol 2010 ◽

pp. 1-11 ◽

Cited By ~ 91

Author(s):

Nektaria Makrilia ◽

Ekaterini Syrigou ◽

Ioannis Kaklamanos ◽

Leonidas Manolopoulos ◽

Muhammad Wasif Saif

Keyword(s):

Signs And Symptoms ◽

Skin Tests ◽

Type I ◽

Platinum Compound ◽

Hypersensitivity Reactions ◽

Management Options ◽

Line Setting ◽

Chemotherapy Agents ◽

Platinum Agents ◽

Rule Out

Platinum-containing chemotherapy agents (cisplatin, carboplatin, oxaliplatin) have been approved in the first-line setting of numerous malignancies, such as ovarian, bladder, head and neck, colorectal, and lung cancer. Their extensive use over the last decade has led to a significant increase in the incidence of hypersensitivity reactions, which are defined as unforeseen reactions whose signs and symptoms cannot be explained by the known toxicity of these drugs. Skin rash, flushing, abdominal cramping, itchy palms, and back pain are common symptoms. Cardiovascular and respiratory complications can prove fatal. Multiple pathogenetic mechanisms have been suggested. Hypersensitivity usually appears after multiple infusions, suggesting type I allergic reactions; however, other types of hypersensitivity also seem to be implicated. Several management options are available to treating physicians: discontinuation of chemotherapy, premedication, prolonging of infusion duration, desensitization protocols, and replacement with a different platinum compound after performing skin tests that rule out cross-reactions among platinum agents.

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Clinical value of negative skin tests to gadolinium contrast agents

Allergy ◽

10.1111/j.1398-9995.2011.02690.x ◽

2011 ◽

Vol 66 (11) ◽

pp. 1504-1506 ◽

Cited By ~ 13

Author(s):

A.-M. Chiriac ◽

Y. Audurier ◽

P. -J. Bousquet ◽

P. Demoly

Keyword(s):

Contrast Agents ◽

Skin Tests ◽

Clinical Value ◽

Gadolinium Contrast ◽

Gadolinium Contrast Agents

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Basophil activation test (BAT) in the diagnosis of immediate hypersensitivity reactions to radiocontrast media

Allergy ◽

10.1111/all.12323 ◽

2013 ◽

Vol 68 (12) ◽

pp. 1627-1629 ◽

Cited By ~ 6

Author(s):

S. Chirumbolo ◽

M. J. Torres

Keyword(s):

Basophil Activation Test ◽

Basophil Activation ◽

Hypersensitivity Reactions ◽

Immediate Hypersensitivity ◽

Activation Test ◽

Radiocontrast Media

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Delayed Cutaneous Hypersensitivity Reactions in Qigong (Chun Do Sun Bup) Trainees by Multitest Cell Mediated Immunity

The American Journal of Chinese Medicine ◽

10.1142/s0192415x95000183 ◽

1995 ◽

Vol 23 (02) ◽

pp. 139-144 ◽

Cited By ~ 16

Author(s):

Hoon Ryu ◽

Haeng Yoeng Mo ◽

Gui Dal Mo ◽

Byung Min Choi ◽

Chang Duk Jun ◽

...

Keyword(s):

Healthy Subjects ◽

Healthy Person ◽

Skin Tests ◽

Cell Mediated Immunity ◽

Hypersensitivity Reactions ◽

Healthy Group ◽

Trainee Group ◽

Cutaneous Hypersensitivity ◽

The Difference ◽

Delayed Cutaneous Hypersensitivity

To determine the difference of cellular immunity between a Qigong trainee group and a normal healthy group, skin tests for delayed cutaneous hypersensitivity (DCH) were carried out with ubiquitous seven antigens. The maximal antigen response time was faster in Qigong trainee group (24 hr) and the response antigen number was also higher in the Qigong trainee group (6 antigens) than in normal healthy person (48 hr and 4 antigens). Qigong trainee also had a larger induration diameter (5.14 mm) than normal healthy person (3.79 mm) at 24 hr. Our results represent the difference in cell mediated immunity (CMI) between Qigong trainees and normal healthy subjects.

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Hypersensitivity reactions to low molecular weight heparins: different patterns of cross-reactivity in 3 patients

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2017-0246 ◽

2018 ◽

Vol 96 (4) ◽

pp. 428-432 ◽

Cited By ~ 1

Author(s):

Danica Juricic Nahal ◽

Ivana Cegec ◽

Viktorija Erdeljic Turk ◽

Ksenija Makar Ausperger ◽

Iva Kraljickovic ◽

...

Keyword(s):

Molecular Weight ◽

Challenge Test ◽

Cross Reactivity ◽

Skin Tests ◽

Delayed Type Hypersensitivity ◽

Low Molecular Weight ◽

Hypersensitivity Reactions ◽

Low Molecular Weight Heparins ◽

Safe Alternative ◽

Delayed Reactions

Low molecular weight heparins (LMWHs) are used for a variety of indications. The most common type of hypersensitivity reactions to LMWHs are delayed-type hypersensitivity reactions (DHR). Immediate-type hypersensitivity reactions (IHR) occur only sporadically. Cross-reactivity of different LMWHs is a common and unpredictable problem. We present 2 cases of patients who developed DHR to nadroparin and enoxaparin, respectively. The third case presents a patient who developed IHR to nadroparin. Skin tests confirmed the hypersensitivity in all cases. In the cases of DHR, a skin test negative LMWH was identified and was tolerated in a challenge test. In the IHR case, cross-reactivity to all tested LMWHs was established. We hypothesize that the degree of cross-reactivity might depend on the type of hypersensitivity reaction with immediate reactions linked to more extensive cross-reactivity than delayed reactions. This is important to consider because, at least in some cases, a safe alternative LMWH can be identified.

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