Intradermal Testing With Radiocontrast Media to Prevent Recurrent Adverse Reactions

被引:6
|
作者
Kim, Sung-Ryeol [1 ,2 ]
Park, Kyung Hee [1 ,2 ]
Hong, Yoo Jin [3 ,4 ]
Oh, Young Taik [3 ,4 ]
Pork, Jung-Won [1 ,2 ]
Lee, Jae-Hyun [1 ,2 ]
机构
[1] Yonsei Univ, Dept Internal Med, Div Allergy & Immunol, Coll Med, 50 Yonsei Ro, Seoul 03722, South Korea
[2] Yonsei Univ, Inst Allergy, Coll Med, Seoul, South Korea
[3] Yonsei Univ, Dept Radiol, Coll Med, Seoul, South Korea
[4] Yonsei Univ, Res Inst Radiol Sci, Coll Med, Seoul, South Korea
关键词
adverse drug reaction; intradermal tests; radiocontrast media; skin tests; IODINATED CONTRAST-MEDIA; HYPERSENSITIVITY REACTIONS; SKIN-TESTS; RISK-FACTORS; IMMEDIATE REACTIONS; DIAGNOSIS; PREMEDICATION; PREVALENCE; OUTCOMES; SAFETY;
D O I
10.2214/AJR.19.21547
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
OBJECTIVE. Adverse drug reactions (ADRs) to radiocontrast media are a significant social and economic burden and are difficult to predict. Because some ADRs to radiocontrast media may be immunologically induced, a skin test with diluted 1:10 radiocontrast media has been used to predict ADRs. However, using this test in clinical practice is difficult because of its low sensitivity. SUBJECTS AND METHODS. This study enrolled 36 patients with a history of immediate ADR to radiocontrast media who visited the Allergy and Asthma Clinic of Severance Hospital from 2017 to 2018. Patients underwent intradermal testing (IDT) with five types of diluted (1:10) and undiluted radiocontrast media (iohexol, iobitridol, iopamidol, iopromide, and iodixanol). The IDT result was regarded as positive if at least one radiocontrast medium elicited a positive reaction. Positivity of IDE and sensitivity to the culprit radiocontrast medium were calculated and compared. For subsequent CT examinations with a radiocontrast medium, the contrast agent eliciting a negative skin reaction in IDT was selected, excluding the previous culprit radiocontrast medium. RESULTS. IDT positivity and sensitivity for the culprit radiocontrast medium at 1:10 dilution were 47.2% and 47.2%, respectively, whereas the positivity and sensitivity for the undiluted radiocontrast medium were 86.1% and 75.0%, respectively. The positivity and sensitivity were higher with frequent radiocontrast medium use or with severe reaction. Of 22 patients who underwent another CT examination with the contrast medium selected on the basis of IDT results, 21 (95.5%) did not experience an ADR. CONCLUSION. IDT to prevent ADR should be performed with undiluted radiocontrast medium. Selecting an alternative radiocontrast agent on the basis of IDT results can be clinically useful to prevent recurrent ADRs to radiocontrast media.
引用
收藏
页码:1187 / 1193
页数:7
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