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Eur J Radiol. 2009 Oct;72(1):167-71. doi: 10.1016/j.ejrad.2008.06.010. Epub 2008 Jul 14.

Radiocontrast media-associated exanthema: identification of cross-reactivity and tolerability by allergologic testing.

Author information

1
Department of Dermatology, Venereology and Allergology, University of Würzburg, Josef Schneider Strasse 2, 97080 Würzburg, Germany.

Abstract

BACKGROUND:

All iodinated radiocontrast media (RCM) may cause hypersensitivity reactions, either immediate-type within 5-10 min of RCM injection or delayed-type, which become apparent more than 1h after RCM exposure. Delayed-type hypersensitivity to RCM may pose a problem for future radiologic investigations because due to possible immunological cross-reactivity all iodinated RCM are usually avoided.

OBJECTIVE:

The aim of this study was not only to identify the causal RCM for the exanthema but also to demonstrate that patients may receive alternative iodinated RCM despite a history of RCM-induced allergic exanthema.

METHODS:

We evaluated 32 patients with a history of exanthema after RCM application using standardized patch, prick and intradermal skin testing. In case of positive skin tests intravenous challenges with skin-test-negative RCM were performed to identify non-ionic monomer RCM which are tolerated.

RESULTS:

In 6 out of 32 patients skin tests strongly suggested a delayed-type non-IgE-mediated allergic hypersensitivity to the RCM iomeprol (3x), iopromide (2x), and iopamidol. In 4 patients alternative non-ionic monomer RCM (2x iosarcol, iopromide, and iomeprol) were identified by controlled challenge tests.

CONCLUSIONS:

The evaluation of patients with RCM-associated exanthema should always include appropriate skin tests ensuring that patients with a delayed-type allergic RCM-induced exanthema are not missed. Moreover, allergologic testing may identify alternative RCM of the group of non-ionic monomers, which are tolerated in future radiologic investigations.

PMID:
18620831
DOI:
10.1016/j.ejrad.2008.06.010
[Indexed for MEDLINE]

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