The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

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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THE CUTANEOUS REACTION TO EGGWHITE

PEDIATRICS ◽

10.1542/peds.24.6.1009 ◽

1959 ◽

Vol 24 (6) ◽

pp. 1009-1015

Author(s):

Richard L. London ◽

Jerome Glaser

Keyword(s):

Skin Test ◽

Skin Testing ◽

Intradermal Test ◽

Skin Tests ◽

Etiologic Factor ◽

Initial Reaction ◽

Age Group ◽

Positive Skin ◽

Clinical Sensitivity ◽

Number Of Patients

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known. In all age groups the family history was positive in about 65% of cases. It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor. In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity. In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test. Only about half the patients of all ages who react to eggwhite are also clinically sensitive. Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied. There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.

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Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

Case Reports in Anesthesiology ◽

10.1155/2020/8163620 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Manzo Suzuki ◽

Hajime Kawase ◽

Azusa Ogita ◽

Hiroyasu Bito

Keyword(s):

General Anesthesia ◽

Skin Testing ◽

Blocking Agent ◽

Cross Reactivity ◽

Neuromuscular Blocking ◽

Intradermal Test ◽

Skin Tests ◽

Prick Test ◽

Causative Drug ◽

Ige Mediated

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

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AstraZeneca ChAdOx1-S COVID-19 Vaccine Can Be Safely Administered in Patients with EDTA Allergy

10.21203/rs.3.rs-1194579/v1 ◽

2021 ◽

Author(s):

Syed Basharat Ali ◽

Griffith Perkins ◽

Dongjae Ryoo ◽

Maverick Lee ◽

Matthew Tunbridge ◽

...

Keyword(s):

Skin Testing ◽

Local Anaesthetics ◽

Intradermal Test ◽

Disodium Edta ◽

Immediate Hypersensitivity ◽

Positive Skin ◽

Radiocontrast Media ◽

Oral Medications ◽

Ethylenediaminetetracetic Acid ◽

History Of

Abstract Background: Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are potentially found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products.Currently patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. We present two cases of previously confirmed EDTA anaphylaxis, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine.Case 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3mg/mL IDT were negative. However, following EDTA 3mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses.Case 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations.Conclusion: Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.

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

Current Drug Safety ◽

10.2174/1574886316666210923143012 ◽

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.

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

10.21203/rs.3.rs-96894/v1 ◽

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.

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What is the clinical value of negative predictive values of skin tests to iodinated contrast media?

Allergy and Asthma Proceedings ◽

10.2500/aap.2016.37.4000 ◽

2016 ◽

Vol 37 (6) ◽

pp. 482-488 ◽

Cited By ~ 5

Author(s):

Şadan Soyyiğit ◽

Özlem Göksel ◽

Ömür Aydın ◽

Zeynep Gençtürk ◽

Sevim Bavbek

Keyword(s):

Contrast Media ◽

Skin Tests ◽

Iodinated Contrast Media ◽

Clinical Value ◽

Predictive Values ◽

Iodinated Contrast

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Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study

Allergo Journal International ◽

10.1007/s40629-020-00134-6 ◽

2020 ◽

Vol 29 (7) ◽

pp. 227-232

Author(s):

Teresa Bangerl ◽

Brigitte Zahel ◽

Andrea Lueger ◽

Emmanuella Guenova ◽

Irena Angelova-Fischer ◽

...

Keyword(s):

Skin Testing ◽

Drug Hypersensitivity ◽

Provocation Test ◽

Clinical History ◽

University Hospital ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Culprit Drug ◽

Inflammatory Drugs ◽

Anti Inflammatory

Summary Background Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of drug hypersensitivity. Despite the importance of NSAIDs in routine analgesia only few studies have systematically addressed the question of tolerability in hypersensitive patients. Methods The authors retrospectively analysed 398 patients that were treated at the Department of Dermatology, Kepler University Hospital Linz, Austria, in the period 2012–2016 with a clinical history of NSAID hypersensitivity. Skin tests (skin prick and intracutaneous tests) to common NSAIDs were performed, followed by single-blinded, placebo-controlled drug challenge with either the culprit drug or an alternative NSAID. Results A total of 361 patients were subjected to skin testing. Of these, 25 patients (6.3%) showed a positive reaction to the culprit drug. According to the severity of the reaction in the medical history, 87 patients were exposed orally to the culprit drug (oral provocation test, OPT) after negative skin test and 255 patients received OPT with alternative NSAIDs according to established protocols. OPT with the culprit drug resulted in hypersensitivity reactions in 12 patients (13.79%). In terms of alternative NSAID testing, the three most commonly tested drugs were lornoxicam (192 OPTs), acetaminophen (156 OPTs) and celecoxib (133 OPTs) with tolerability rates in respectively 88.54% (hypersensitivity reactions, 11.46%), 92.31% (hypersensitivity reactions, 7.69%) and 91.73% (hypersensitivity reactions, 8.27%) of cases. Conclusion OPT with alternative NSAIDs are useful in patients with NSAID hypersensitivity as tolerability varies between the individual substances.

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