The Potential Utility of Iodinated Contrast Media (ICM) Skin Testing in Patients with ICM Hypersensitivity
The Potential Utility of Iodinated Contrast Media (ICM) Skin Testing in Patients with ICM Hypersensitivity
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DOI：
10.3346/jkms.2015.30.3.245
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发表时间：
2015-03-01
影响因子：
4.5
通讯作者：
Ye, Young-Min
中科院分区：
文献类型：
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作者：
Ahn, Young-Hwan;Koh, Young-Il;Ye, Young-Min
碘化造影剂（ICM）的速发型和迟发型超敏反应相对常见。然而，很少有数据来确定ICM免疫学评价的临床效用。为了评价ICM皮肤试验在ICM超敏反应患者中的效用，从韩国3家大学医院入组了23例患者（17例速发型反应和6例迟发型反应）。对碘普罗胺、碘海醇、碘佛醇、碘美普尔、碘帕醇和碘克沙醇6种常用ICM进行皮肤点刺试验、皮内试验和斑贴试验。10例过敏反应患者中，SPT和IDT分别有3例（30.0%）和6例（60.0%）阳性。6例荨麻疹患者中3例IDT阳性。共11例（64.7%）SPT或IDT阳性。6例迟发性皮疹中3例斑贴试验和/或迟发性IDT阳性。5例患者（3例过敏反应，1例荨麻疹和1例迟发性皮疹）进行了后续放射学检查，3例患者根据皮试结果给予安全替代品，无不良反应。然而，另外2例再次给予罪犯ICM的患者发生了速发过敏反应。用罪犯ICM进行的相应过敏性皮肤试验对速发型和迟发型超敏反应的敏感性分别为64.7%（11/17）和50%（3/6），本研究表明皮肤试验对ICM超敏反应的诊断、选择安全的ICM和预防由同一ICM引起的过敏反应的复发是有用的。
Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.