CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

ANAPHYLAXIS INDUCED BY RADIOCONTRAST MEDIA

Taha Yasin Akın

Kocaeli University, Faculty of Medicine, Department of Pediatric Immunology and Allergic Diseases, Kocaeli, Türkiye

Akın TY. Anaphylaxis Induced by Radıocontrast Media. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.167-175.

ABSTRACT

Radiocontrast media are classified into two categories: iodinated and gadolinium-based. Severe reactions with iodinated radiocontrast media occur in 0.005% to 0.013% of cases, while this rate is 0.002% to 0.004% for gadolinium-based radiocontrast media. Early-type hypersensitivity reactions can manifest as urticaria and/or angioedema, but they can also present as life-threatening severe anaphylaxis, including respiratory failure and cardiovascular collapse. Skin tests, in vitro tests, and drug provocation tests can be used to make a definitive diagnosis after a detailed clinical history or, if necessary, to select an alternative radiocontrast agent. Since there is a risk of cross-reaction among radiocontrast agents, the selection of alternative agents should be performed with caution. Non-ionic iodinated radiocontrast media is categorized based on the common carbamoyl side chain to assess the potential for cross-reactivity. Gadolinium-based radiocontrast media are evaluated for cross-reactivity by categorizing them according to the chelating agent.

Keywords: Radiocontrast media; Anaphylaxis; Radiocontrast media allergy; Iodinated radiocontrast media; Gadolinium-based radiocontrast media

Referanslar

  1. Sauer N, Szlasa W, Jonderko L, Głowacka K, Karłowicz-Bodalska K, Wiela-Hojeńska A. Contrast Media Adverse Drug Reactions in Highly Polluted Environment. Int J Environ Res Public Health. 2022;19(12):7077. [Crossref]  [PubMed]  [PMC]
  2. Dawson P, Howell M. The non-ionic dimers: a new class of contrast agents. Br J Radiol. 1986;59(706):987-991. [Crossref]  [PubMed]
  3. Macy EM. Current Epidemiology and Management of Radiocontrast-Associated Acuteand Delayed-Onset Hypersensitivity: A Review of the Literature. Perm J. 2018;22. [Crossref]  [PubMed]  [PMC]
  4. Brockow K, Christiansen C, Kanny G, Clément O, Barbaud A, Bircher A, et al. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005;60(2):150-158. [Crossref]  [PubMed]
  5. Cha MJ, Kang DY, Lee W, Yoon SH, Choi YH, Byun JS, et al. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients. Radiology. 2019;293(1):117-124. [Crossref]  [PubMed]
  6. Hunt CH, Hartman RP, Hesley GK. Frequency and Severity of Adverse Effects of Iodinated and Gadolinium Contrast Materials: Retrospective Review of 456,930 Doses. American Journal of Roentgenology. 2009;193(4):1124-1127. [Crossref]  [PubMed]
  7. McDonald JS, Hunt CH, Kolbe AB, Hunt CH, Schmitz JJ, Daniel EM, et al. Acute Adverse Events Following Gadolinium-based Contrast Agent Administration: A Single-Center Retrospective Study of 281 945 Injections. Radiology. 2019;292(3):620-627. [Crossref]  [PubMed]
  8. Park HJ, Park JW, Yang MS, Kim MY, Kim SH, Jang GC, et al. Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study. Eur Radiol. 2017;27(7):2886-2893. [Crossref]  [PubMed]
  9. Jung JW, Choi YH, Park CM, Park HW, Cho SH, Kang HR. Outcomes of corticosteroid prophylaxis for hypersensitivity reactions to low osmolar contrast media in high-risk patients. Annals of Allergy, Asthma & Immunology. 2016;117(3):304309.e1. [Crossref]  [PubMed]
  10. Brockow K, Ardern-Jones MR, Mockenhaupt M, Aberer W, Barbaud A, Caubet JC, et al. EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity. Allergy. 2019;74(1):14-27. [Crossref]  [PubMed]
  11. Mayorga C, Fernandez TD, Montañez MI, Moreno E, Torres MJ. Recent developments and highlights in drug hypersensitivity. Allergy. 2019;74(12):2368-2381. [Crossref]  [PubMed]
  12. Torres MJ, Trautmann A, Böhm I, Scherer K, Barbaud A, Bavbek S, et al. Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity. Allergy. 2021;76(5):1325-1339. [Crossref]  [PubMed]
  13. Rosado Ingelmo A, Doña Diaz I, Cabañas Moreno R, Moya Quesada MC, Garcia-Aviles C, Garcia Nunez I, et al. Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media. J Investig Allergol Clin Immunol. 2016;26(3):144-155. [Crossref]  [PubMed]
  14. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175(3):621-628. [Crossref]  [PubMed]
  15. Böhm I, Heverhagen JT, Klose KJ. Classification of acute and delayed contrast media-induced reactions: proposal of a three-step system. Contrast Media Mol Imaging. 2012;7(6):537-541. [Crossref]  [PubMed]
  16. Brockow K. An algorithm for the management of radiocontrast media hypersensitivity, 2024 update. Allergy: European Journal of Allergy and Clinical Immunology. 2024;79(9):2570-2572. [Crossref]  [PubMed]
  17. Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: A 2022 practice parameter update. Journal of Allergy and Clinical Immunology. 2022;150(6):1333-1393. [Crossref]  [PubMed]
  18. Salas M, Gomez F, Fernandez TD, Dona I, Aranda A, Ariza A, et al. Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy. 2013;68(9):12031206. [Crossref]  [PubMed]
  19. Dewachter P, Mouton-Faivre C, Felden F. Allergy and contrast media. Allergy. 2001;56(3):250-251. [Crossref]  [PubMed]
  20. Trcka J, Schmidt C, Seitz CS, Bröcker EB, Gross GE, Trautmann A. Anaphylaxis to Iodinated Contrast Material: Nonallergic Hypersensitivity or IgE-Mediated Allergy? American Journal of Roentgenology. 2008;190(3):666-670. [Crossref]  [PubMed]
  21. Goksel O, Aydın O, Atasoy C, Akyar S, Demirel YS, Misirligil Z, et al. Hypersensitivity Reactions to Contrast Media: Akın Anaphylaxis Induced by Radıocontrast Media Prevalence, Risk Factors and the Role of Skin Tests in Diagnosis - A Cross-Sectional Survey. Int Arch Allergy Immunol. 2011;155(3):297-305. [Crossref]  [PubMed]
  22. Yoon SH, Lee SY, Kang HR, Kim JY, Hahn S, Park CM, et al. Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy. 2015;70(6):625-637. [Crossref]  [PubMed]
  23. Trautmann A, Brockow K, Behle V, Stoevesandt J. Radiocontrast Media Hypersensitivity: Skin Testing Differentiates Allergy From Nonallergic Reactions and Identifies a Safe Alternative as Proven by Intravenous Provocation. J Allergy Clin Immunol Pract. 2019;7(7):2218-2224. [Crossref]  [PubMed]
  24. Mayorga C, Celik G, Rouzaire P, Moreno E, Torres MJ. In vitro tests for drug hypersensitivity reactions: an ENDA/ EAACI Drug Allergy Interest Group position paper. Allergy. 2016;71(8):1103-1134. [Crossref]  [PubMed]
  25. Stone SF, Cotterell C, Isbister GK, Holdgate A, Brown SGA. Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions. Journal of Allergy and Clinical Immunology. 2009;124(4):786-792.e4. [Crossref]  [PubMed]
  26. Schwartz L, Atkins P, Bradford T, Fleekop P, Shalit M, Zweiman B. Release of tryptase together with histamine during the immediate cutaneous response to allergen. Journal of Allergy and Clinical Immunology. 1987;80(6):850-855. [Crossref]  [PubMed]
  27. Hoffmann HJ, Santos AF, Mayorga C, et al. The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease. Allergy: European Journal of Allergy and Clinical Immunology. 2015;70(11):1393-1405. [Crossref]  [PubMed]
  28. Pinnobphun P, Buranapraditkun S, Kampitak T, Hirankarn N, Klaewsongkram J. The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media. Annals of Allergy, Asthma & Immunology. 2011;106(5):387-393. [Crossref]  [PubMed]
  29. Gracia Bara MT, Gallardo-Higueras A, Moreno EM, Laffond E, Bellidino FJM, Martin C, et al. Hypersensitivity to Gadolinium-Based Contrast Media. Frontiers in Allergy. 2022;3. [Crossref]  [PubMed]  [PMC]
  30. Mankouri F, Gauthier A, Srisuwatchari W, Moutou A, Borushko A, Popa L, et al. Hypersensitivity to gadolinium-based contrast agents: A single-center retrospective analysis over 7 years. J Allergy Clin Immunol Pract. 2021;9(4):1746-1749. e2. [Crossref]  [PubMed]
  31. Kolenda C, Dubost R, Hacard F, Mullet C, Le Quang D, Garnier L, et al. Evaluation of basophil activation test in the management of immediate hypersensitivity reactions to gadolinium-based contrast agents: a five-year experience. J Allergy Clin Immunol Pract. 2017;5(3):846-849. [Crossref]  [PubMed]
  32. Barbaud A, Garvey LH, Torres M, Laguna JJ, Arcolaci A, Bonadonna P, et al. EAACI/ENDA position paper on drug provocation testing. Allergy. 2024;79(3):565-579. [Crossref]  [PubMed]
  33. Soyer O, Sahiner UM, Sekerel BE. Pro and Contra: Provocation Tests in Drug Hypersensitivity. Int J Mol Sci. 2017;18(7):1437. [Crossref]  [PubMed]  [PMC]
  34. Lee SY, Yang MS, Choi YH, Park CM, Park HW, Cho SH, et al. Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients. Annals of Allergy, Asthma & Immunology. 2017;118(3):339-344.e1. [Crossref]  [PubMed]
  35. Cha MJ, Kang DY, Lee W, Yoon SH, Choi SH, Byun JS, et al. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients. Radiology. 2019;293(1):117-124. [Crossref]  [PubMed]
  36. Pradubpongsa P. Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome - the results of a 3-year period. Asian Pac J Allergy Immunol. 2013;31(4). [Crossref]  [PubMed]
  37. Mervak BM, Davenport MS, Ellis JH, Cohan RH. Rates of Breakthrough Reactions in Inpatients at High Risk Receiving Premedication Before Contrast-Enhanced CT. American Journal of Roentgenology. 2015;205(1):77-84. [Crossref]  [PubMed]
  38. Abe S, Fukuda H, Tobe K, Ibukuro K. Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium. Eur Radiol. 2016;26(7):2148-2154. [Crossref]  [PubMed]
  39. McDonald JS, Larson NB, Kolbe AB, Hunt CH, Schmitz JJ, Maddox DE, et al. Prevention of Allergic-like Reactions at Repeat CT: Steroid Pretreatment versus Contrast Material Substitution. Radiology. 2021;301(1):133-140. [Crossref]  [PubMed]
  40. Umakoshi H, Nihashi T, Takada A, Hirasawa N, Ishihara S, Takehara Y, et al. Iodinated Contrast Media Substitution to Prevent Recurrent Hypersensitivity Reactions: A Systematic Review and Meta-Analysis. Radiology. 2022;305(2):341-349. [Crossref]  [PubMed]
  41. Vega F, van de Ven AAJM, van der Molen AJ. Cross-reactivity in hypersensitivity reactions to contrast agents: new classification and guide for clinical practice. Eur Radiol. 2024;34(12):7583-7588. [Crossref]  [PubMed]
  42. Seitz CS, Pfeuffer P, Raith P, Bröcker EB, Trautmann A. Radiocontrast media-associated exanthema: Identification of cross-reactivity and tolerability by allergologic testing. Eur J Radiol. 2009;72(1):167-171. [Crossref]  [PubMed]
  43. Hasdenteufel F, Waton J, Cordebar V, Studer M, Collignon O, Luyasu S, et al. Delayed hypersensitivity reactions caused by iodixanol: An assessment of cross-reactivity in 22 patients. Journal of Allergy and Clinical Immunology. 2011;128(6):1356-1357. [Crossref]  [PubMed]
  44. Schmid AA, Morelli JN, Hungerbühler MN, Boehm IB. Cross-reactivity among iodinated contrast agents: should we be concerned? Quant Imaging Med Surg. 2021;11(9):40284041. [Crossref]  [PubMed]  [PMC]
  45. Ghiordanescu IM, Molinari N, Ciocănea-Teodorescu I, Schrijvers R, Motei C, Forsea AM, et al. Skin Test Reactivity Patterns in Patients Allergic to Iodinated Contrast Media: A Refined View. J Allergy Clin Immunol Pract. 2024;12(3):705713.e6. [Crossref]  [PubMed]
  46. Kim SR, Son NH, Park HJ, Park KH, Park JW, Lee JH. Differences in the Recurrence Rate of Immediate Adverse Drug Reactions According to the Components of Alternative Contrast Media: Analysis of Repetitive Computed Tomography Cases in a Single Tertiary Hospital. Drug Saf. 2022;45(9):995-1002. [Crossref]  [PubMed]
  47. Ruiz de Azcárate PH, López-Sanz C, López-Raigada A, Vega F, Jiménez-Saiz R, Blanco C. Meglumine gadoterate induces immunoglobulin-independent human mast cell activation via MRGPRX2. Allergy. 2023;78(12):3255-3258. [Crossref]  [PubMed]
  48. Bjørbak Alnæs M. Include desensitization to radiocontrast media in the diagnostic algorithm of radio contrast media hypersensitivity. Allergy. 2021;76(4):1302-1303. [Crossref]  [PubMed]