Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity

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  • María José Torres
    Allergy Unit Regional University Hospital of Malaga‐IBIMA‐UMA‐ARADyAL Malaga Spain
  • Axel Trautmann
    Department of Dermatology and Allergy University Hospital Würzburg Würzburg Germany
  • Ingrid Böhm
    Department of Diagnostic, Interventional, and Pediatric Radiology Inselspital University of Bern Bern Switzerland
  • Kathrin Scherer
    Allergology University Hospital Basel Basel Switzerland
  • Annick Barbaud
    Service de Dermatologie et Allergologie Sorbonne Université INSERM Institut Pierre Louis d’Epidemiologie et de Sante Publique AP‐HP Sorbonne Universite, Hopital Tenon Paris France
  • Sevim Bavbek
    Department of Chest Disease Division of Immunology and Allergy School of Medicine Ankara University Ankara Turkey
  • Patrizia Bonadonna
    Allergy Unit Verona University Hospital Verona Italy
  • Josefina Rodrigues Cernadas
    Department of Allergy and Immunology Centro Hospitalar Universitário de S João Porto Portugal
  • Anca Mirela Chiriac
    Department of Pulmonology Division of Allergy Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
  • Francesco Gaeta
    Allergy Unit Columbus Hospital Agostino Gemelli IRCCS University Hospital Rome Italy
  • Ana M. Gimenez‐Arnau
    Department of Dermatology Hospital del Mar IMIM Universitat Autònoma Barcelona Barcelona Spain
  • Hye‐Ryun Kang
    Department of Internal Medicine Division of Allergy and Clinical Immunology Seoul National University College of Medicine Seoul Korea
  • Esther Moreno
    Allergy Unit University Hospital of Salamanca‐IBSAL‐UMA‐ARADyAL Salamanca Spain
  • Knut Brockow
    Department of Dermatology and Allergy Biederstein School of Medicine Technical University of Munich Munich Germany

Abstract

<jats:title>Abstract</jats:title><jats:p>Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%‐3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re‐exposition or drug provocation test should only be done with skin test‐negative ICMs. The decision for performing either re‐exposition or drug provocation test needs to be taken based on a risk‐benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial.</jats:p>

Journal

  • Allergy

    Allergy 76 (5), 1325-1339, 2021-05

    Wiley

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