scholarly journals Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

2021 ◽  
Vol 35 ◽  
pp. 205873842110150
Author(s):  
Rakesh D Bansie ◽  
A Faiz Karim ◽  
Maurits S van Maaren ◽  
Maud AW Hermans ◽  
Paul LA van Daele ◽  
...  
Keyword(s):  
Contrast Media ◽  
Skin Test ◽  
Positive Skin Test ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
Provocation Tests ◽  
Iodinated Contrast ◽  
Negative Skin Test

Introduction: Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. Methods: A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. Results: Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. Conclusion: In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

scholarly journals Premedication for Iodinated Contrast Media Induced Immediate Hypersensitivity Reactions

2019 ◽  
Vol 6 (4) ◽  
pp. 538-553
Author(s):  
Rik Schrijvers ◽  
Pascal Demoly ◽  
Anca Mirela Chiriac
Keyword(s):  
Contrast Media ◽  
Skin Test ◽  
Diagnostic Delay ◽  
Initial Reaction ◽  
Number Needed To Treat ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Immediate Hypersensitivity ◽  
Iodinated Contrast

Abstract Purpose of the review Premedication using antihistamines and/or corticosteroids has been widely used to prevent reoccurrence of immediate hypersensitivity reactions (iHR) after iodinated contrast media (ICM). However, efficacy has been debated, especially in high-risk patients. Novel findings on the role and risks of premedication and preventive strategies are summarized. Recent findings The rate and severity of iHR occurring despite premedication indicate that premedication is not a panacea and the intensity usually reflects that of the initial reaction. Next, the number needed to treat (NNT) to prevent one serious ICM-mediated event using corticosteroid-based premedication is high and associated with a diagnostic delay. Randomly changing the ICM has been suggested as an additional preventive measure, whilst others used a skin test–based approach to identify a subgroup of ICM allergic patients and negative skin test–based alternatives with a high negative predictive value. Summary Growing evidence indicates the need to discriminate between non-allergic iHR that are most likely non-obligatory and susceptible to premedication, and rare type I allergic iHR that can be identified using skin testing, especially in those with a severe iHR. Although premedication reduces reoccurrence of mild iHR, it is not always efficacious and should be balanced against side effects, a high NNT and an uncertain efficacy physicians should not blindly rely on. Future work should evaluate combined approaches of an allergy-driven ICM selection and endotype-driven premedication regimens in patients with non-allergic iHR.

Penicillin Hypersensitivity

1979 ◽  
Vol 1 (5) ◽  
pp. 132-158
Keyword(s):  
Skin Test ◽  
Multicenter Study ◽  
Positive Skin Test ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Penicillin G ◽  
Positive Skin ◽  
Positive History ◽  
History Of

A (massive) multicenter study of 3,000 patients has demonstrated that skin tests to penicillin G and penicilloyl-polylysine (PPL-now commercially available) predict and confirm penicillin allergy. Of patients with a history of penicillin reaction, 19% were positive to either, compared to 7% of controls. A history of anaphylaxis led to 46% positive. Of those with a history of urticaria 17% were positive, and those with maculopapular eruptions did not differ from controls (7% positive). Challenge with penicillin led to a reaction in 6% with a positive history (compared to 2% with a negative) and 67% with a combined positive history and positive skin test (to either).

scholarly journals Hypersensitivity reactions to iodinated contrast media

2019 ◽  
Vol 16 (3) ◽  
pp. 85-91
Author(s):  
L G Khludova ◽  
T N Myasnikova ◽  
V V Smirnov ◽  
T V Latysheva ◽  
M R Khaitov
Keyword(s):  
Contrast Media ◽  
Contrast Agents ◽  
Previous History ◽  
Skin Tests ◽  
Public Health Issue ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
Alternative Agent ◽  
History Of

Hypersensitivity reactions to iodinated contrast media are a pressing public health issue. Lack of understanding of pathogenetic mechanisms of such reactions leads to unjustified refuse of diagnostic and therapeutic procedures using iodinated contrast agents. Reactions of hypersensitivity to other iodine-containing medications are not a contraindication for use of contrast agents. Skin allergy tests are only performed in the patients who had a history of allergic reactions to iodinated contrast media. Usually it is possible to determine an alternative agent by means of skin tests. Premedication before a contrast-enhanced radiological examination has to be indicated to all patients with previous history of allergic disease.

scholarly journals Evaluation of a New Routine Diagnostic Test for Immunoglobulin E Sensitization to Neuromuscular Blocking Agents

2011 ◽  
Vol 114 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Dominique Laroche ◽  
Sylvie Chollet-Martin ◽  
Pierre Léturgie ◽  
Laure Malzac ◽  
Marie-Claude Vergnaud ◽  
...  
Keyword(s):  
Skin Test ◽  
Quaternary Ammonium ◽  
Immunoglobulin E ◽  
Solid Phase ◽  
Specific Ige ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity

Background Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion. The aim of this study was to evaluate the diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. Methods We tested 168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 patients had positive skin tests to the administered NMBA, whereas 57 had negative skin tests. Specific IgE concentrations determined with the QAM method based on a morphine solid phase were compared with those obtained with a recommended experimental method with a choline solid phase. Results For the QAM test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive reactors (80.7% with the recommended method; no significant difference), and binding was inhibited by the culprit NMBA in 80% of cases. The frequency of QAM-specific IgE positivity was significantly higher in skin test-negative reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. Conclusion Sensitivity of the QAM test (84.2%), together with its simplicity and suitability for routine laboratory use, makes it a valuable tool, in conjunction with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA injection. The QAM test is of particular interest when skin tests are not available or not reliable or give results poorly compatible with mediator release or clinical features.

Delayed Cutaneous Hypersensitivity Reaction to Carcinoembryonic Antigen in Cancer Patients

1982 ◽  
Vol 68 (6) ◽  
pp. 473-475 ◽  
Author(s):  
Sergio Orefice ◽  
Giuseppe Fossati ◽  
Enrico Pietrojusti ◽  
Giuliano Bonfanti
Keyword(s):  
Hypersensitivity Reaction ◽  
Carcinoembryonic Antigen ◽  
Skin Test ◽  
Positive Skin Test ◽  
Hypersensitivity Reactions ◽  
Degenerative Diseases ◽  
Positive Skin ◽  
Cutaneous Hypersensitivity ◽  
Test Reactions ◽  
Delayed Cutaneous Hypersensitivity

The delayed cutaneous hypersensitivity reaction to carcinoembryonic antigen (CEA) was tested in 84 patients with different diseases including large bowel adenocarcinoma and breast carcinoma, with or without metastasis, liver cirrhosis and inflammatory or degenerative diseases. Positive skin test to CEA was observed in a small proportion (11 %) of the patients tested. No difference in positive skin test reactions was observed in the 6 different groups of patients. Similar delayed cutaneous hypersensitivity reactions were found to various amount of CEA ranging from 0.5 to 25 μg. No correlation was seen between the results of skin test and blood CEA levels.

Skin tests for the exploration of hypersensitivity reactions associated with iodinated contrast media

2021 ◽  
Vol 16 ◽  
Author(s):  
Ahmed Zaiem ◽  
Syrine Ben Hammamia ◽  
Fares Ben Salem ◽  
Ons Charfi ◽  
Imen Aouinti ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hypersensitivity Reaction ◽  
Contrast Media ◽  
Skin Testing ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
Intradermal Tests ◽  
The One

Background: Iodinated contrast media (ICM) are responsible for multiple side effects, especially hypersensitivity reactions. These reactions can either be authentic allergies, or non-allergic hypersensitivity reactions. Skin tests (prick and intradermal tests) are simple to perform and can be of great help, especially if the ICM need to be re-used. The aim of the study was to assess the characteristics of the patients in whom skin tests were performed, and the results of these tests. Methods: This is a retrospective study from June 2014 to June 2019. All included patients had at least one episode of hypersensitivity reaction to ICM and underwent skin tests. Results : We included 35 patients aged 18 to 85 years. The iopromide was the most implicated ICM. The reactions were mainly cutaneous (n=30) and immediate (n=27). The skin tests were negative, except for two patients. The reuse of ICM occured in 11 patients: 9 with an ICM other than the one suspected and two patients with the same ICM. Among these patients, 5 did not have any premedication. Two of them had a second hypersensitivity reaction, the first with another ICM and the second with the same ICM. Conclusion: One of the main pillars of allergic exploration is ICM skin testing, not only to prevent recurrence, but also to allow patients to benefit from ICM reuse, which are sometimes essential.

scholarly journals Features of delayed hypersensitivity reactions to iodinated contrast media diagnosis. Clinical cases

2013 ◽  
Vol 10 (3) ◽  
pp. 35-40
Author(s):  
N V Lebedeva ◽  
T N Myasnikova ◽  
T V Latysheva
Keyword(s):  
Contrast Media ◽  
Delayed Hypersensitivity ◽  
Skin Tests ◽  
Delayed Type Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
History Of ◽  
Clinical Cases

The article presents the proprietary data of the survey of patients who had undergone a history of hypersensitivity reactions after administration of iodinated contrast media (RCM), the estimation of skin tests with RCM in these patients and two clinical cases of patients who had a history of delayed-type hypersensitivity.

scholarly journals Immediate Reactions to Iodinated Contrast Media Prevalence of IgE-mediated Hypersensitivity

2020 ◽  
Author(s):  
Juliette Caron ◽  
Maxime SEYNAVE ◽  
Sahara GRAF ◽  
Tomas MORALY ◽  
Christine DELEBARRE-SAUVAGE
Keyword(s):  
Contrast Media ◽  
Skin Testing ◽  
Skin Tests ◽  
Iodinated Contrast Media ◽  
Provocation Tests ◽  
Iodinated Contrast ◽  
Intradermal Tests ◽  
Ige Mediated ◽  
Low Prevalence ◽  
Work Up

Abstract BackgroundAfter administration of iodinated contrast media (ICM) some patients develop an immediate hypersensitivity reaction (IHR). A specific allergic IgE-mediated mechanism may be involved. ObjectiveTo determine the prevalence of allergic patients among ICM reactors and to evaluate the negative predictive value (NVP) of skin testing for ICM.MethodsAll patients who attended a single center for an allergy work-up between 2010 and 2019 due to a prior IHR after an ICM injection were included retrospectively. ICM allergy was diagnosed if prick tests or intradermal tests were positive. Further information concerning secondary exposure to ICM was obtained from all patients with negative skin tests to determine whether ICM re-exposure led to an IHR.ResultsSkin tests identified ICM allergy in 7 out of 85 patients (8.2%). Frequency of IgE-mediated hypersensitivity among patients increased with increasing reaction severity. The NPV of skin testing for ICM allergy was 87.8% [95%CI 75.2;95.4.ConclusionThe low prevalence of IgE-mediated hypersensitivity among patients with IHR to ICM should not delay allergy workup. Earlier skin tests and provocation tests with skin-test negative ICM may help allergists to find a reliable alternative ICM.

The Effect of Repeated Mumps Skin Tests on Skin Sensitivity to Mumps Antigen

PEDIATRICS ◽  
1965 ◽  
Vol 36 (3) ◽  
pp. 422-425
Author(s):  
SUSAN S. ARONSON ◽  
MARTHA L. LEPOW
Keyword(s):  
Skin Test ◽  
Antibody Titer ◽  
Mumps Virus ◽  
Positive Skin Test ◽  
Skin Tests ◽  
Subclinical Infection ◽  
Skin Sensitivity ◽  
Positive Skin ◽  
Skin Hypersensitivity ◽  
Clinical Illness

The mumps skin test, developed by Enders et al., in 1945, has been especially useful in identifying individuals who are immune to mumps either as a result of clinical illness caused by the mumps virus or a subclinical infection. A positive skin test can be demonstrated in 98% of persons who have a rise in complement-fixing antibody titer to mumps virus, and skin hypersensitivity may develop from 1 week to 3 months after infection. Although repeated skin tests with mumps antigen are not commonly performed, occasionally it is necessary to repeat a skin test within a few months or a year after a previous one.

Sign in / Sign up

Export Citation Format

Share Document