Allergy Asthma Respir Dis.  2016 Nov;4(6):442-448. 10.4168/aard.2016.4.6.442.

Prevalence and clinical features of hypersensitivity reaction to contrast media after prescreening skin test

• Park BB
• Park CH
• Nho IY
• Kim HS
• Kang NK
• Chang SI
• Kim JM

• KMID: 2361260
• DOI: http://doi.org/10.4168/aard.2016.4.6.442

Abstract

PURPOSE
Hypersensitivity reactions to contrast media (CM) are one of the most common causes of drug adverse reactions. The overall prevalence of immediate hypersensitivity reaction (IHR) was 0.16%-7.7% to nonionic CM. Although IHR to CM has been traditionally considered nonallergic, there is growing evidence that the mechanism of IHR to CM is mediated by IgE. It can be severe, even fatal, and a legal problem. To reduce IHR, the prescreening skin test is on the rise.
METHODS
We reviewed cases of IHR to CM during enhanced computed tomography (CT) from 2008 to 2015 at a secondary hospital in South Korea. Patients who underwent enhanced CT were performed the 2-step prescreening skin test before nonionic CM-enhanced CT. If patients had adverse reactions to CM, the reactions were reported. IHR to CM was defined as an immediate reaction within 1 hour after CM administration. The Ring and Messmer system was used to classify the severity of reactions by grades I to IV, and we defined grades III and IV as severe reactions.
RESULTS
A total of 30,105 CM-enhanced CT cases were recruited from 2008 to 2015. A total 46 patients with CM adverse reactions were reported. The IHR were noted in 30 of the total patients (0.1%), of which 6 had severe reaction.
CONCLUSION
The prevalences of IHR and severe IHR to CM were 0.1% and 0.02%, respectively. Further studies are needed to evaluate the usefulness of prescreening skin tests to prevent IHR to CM.

Keyword

Contrast media; Hypersensitivity reaction; Skin test

MeSH Terms

Contrast Media*
Humans
Hypersensitivity*
Hypersensitivity, Immediate
Immunoglobulin E
Korea
Prevalence*
Skin Tests*
Skin*
Contrast Media
Immunoglobulin E

Figure

• 

  Fig. 1 Two-step prescreening skin testing. CM, contrast media; DM, diabetes mellitus; CT, computed tomography. *The first skin test was performed with a nonionic CM commonly used in our hospital. (mostly iohexol). **If a patient had a negative response to both 2 nonionic CM, one of them were selected randomly, If a patient had a negative response to only one nonionic CM, enhanced CT was performed by using the nonionic CM with negative reaction.

• 

  Fig. 2 The contrast media-related adverse reaction from 2008 to 2015. CT, computed tomography.

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