Dataset Information

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study.

ABSTRACT:

Background

Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.

Methods

Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.

Findings

Among 245 skin-tested patients (ICM?=?209; GBCM?=?36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p?InterpretationAllergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

SUBMITTER: Clement O

PROVIDER: S-EPMC6537532 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study.

Clement Olivier O Dewachter Pascale P Mouton-Faivre Claudie C Nevoret Camille C Guilloux Laurence L Bloch Morot Evelyne E Katsahian Sandrine S Laroche Dominique D Audebert Martine M Benabes-Jezraoui Béatrice B Benoit Yves Y Beot Sylvie S Berard Frédéric F Berthezene Yves Y Bertrand Philippe P Bouffard Juliette J Bourrain Jean-Luc JL Boyer Bruno B Carette Marie-France MF Caron-Poitreau Christine C Cavestri Béatrice B Cercueil Jean Pierre JP Charpin Denis-André DA Collet Evelyne E Crombe-Ternamian Arielle A Dalmas Jacques J Decoux Eric E Defrance Marie-France MF Delaval Yvonne Y Demoly Pascal P Depriester Claude C Depriester Pascale P Didier Alain A Drouet Martine M Dupas Benoît B Dupre-Goetchebeur Dominique D Dzviga Charles C Fabre Christine C Ferretti Gilbert G Fourre-Jullian Corinne C Girardin Pascal P Giron Jacques J Gouitaa Marion M Grenier Nicolas N Guenard Bilbault Lydie L Guez Stéphane S Gunera-Saad Nathalie N Heautot Jean-François JF Herbin Dominique D Hoarau Cyrille C Jacquot Claude C Julien Christian C Laborie Laurent L Lambert Claude C Larroche Pascal P Leclerc Xavier X Lemaitre Laurent L Leynadier Francisque F Lillo-Le-Louet Agnès A Louvel Jean-Pierre JP Louvier Nathalie N Lucas Marie-Madeleine MM Meites Geneviève G Mennesson Nicolas N Metge Liliane L Meunier Yannick Y Monnier-Cholley Laurence L Musacchio Mariano M Nicolie Brigitte B Occelli Gisèle G Oesterle Hélène H Paisant-Thouveny Francine F Panuel Michel M Railhac Nadine N Rety-Jacob Frédérique F Rochefort-Morel Cécile C Roy Catherine C Sarlieve Philippe P Sesay Musa M Sgro Catherine C Taourel Patrice P Terrier Patrick P Theissen Odile O Topenot Ingrid I Valfrey Jocelyne J Veillon Francis F Vergnaud Marie-Claude MC Veyret Charles C Vincent Denis D Wallaert Benoit B Wessel François F Zins Marc M

EClinicalMedicine 20180728

<h4>Background</h4>Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.<h4>Methods</h4>Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed b ...[more]

PMID: 31193689

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Project description:Background and purposeGadolinium-based contrast agents have been associated with lasting high T1-weighted signal intensity in the dentate nucleus and globus pallidus, with histopathologically confirmed gadolinium retention. We aimed to longitudinally investigate the relationship of multiple gadolinium-based contrast agent administrations to the Signal Intensity Index in the dentate nucleus and globus pallidus and any associations with cognitive function in multiple sclerosis.Materials and methodsThe Signal Intensity Index in the dentate nucleus and globus pallidus was retrospectively evaluated on T1-weighted MR imaging in an 18-year longitudinal cohort study of 23 patients with MS receiving multiple gadolinium-based contrast agent administrations and 23 healthy age- and sex-matched controls. Participants also underwent comprehensive neuropsychological testing.ResultsPatients with MS had a higher Signal Intensity Index in the dentate nucleus (P < .001), but not in the globus pallidus (P = .19), compared with non-gadolinium-based contrast agent-exposed healthy controls by an unpaired t test. Increasing numbers of gadolinium-based contrast agent administrations were associated with an increased Signal Intensity Index in the dentate nucleus (β = 0.45, P < .001) and globus pallidus (β = 0.60, P < .001). This association remained stable with corrections for the age, disease duration, and physical disability for both the dentate nucleus (β = 0.43, P = .001) and globus pallidus (β = 0.58, P < .001). An increased Signal Intensity Index in the dentate nucleus among patients with MS was associated with lower verbal fluency scores, which remained significant after correction for several aspects of disease severity (β = -0.40 P = .013).ConclusionsOur data corroborate previous reports of lasting gadolinium retention in brain tissues. An increased Signal Intensity Index in the dentate nucleus and globus pallidus was associated with lower verbal fluency, which does not prove causality but encourages further studies on cognition and gadolinium-based contrast agent administration.

Project description:The incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer after ICM administration. The diagnosis of HSRs to ICM is complex as skin test (ST) sensitivity ranges widely, and drug provocation test (DPT) protocols are heterogeneous. In this manuscript, we describe the clinical characteristics of a series of patients confirmed as HSR to ICM and the diagnosis procedure carried out, looking into those cases confirmed as HSRs to multiple ICMs. For this purpose, we prospectively evaluated patients suggestive of HSRs to ICMs and classified them as IRs or NIRs. STs were carried out using a wide panel of ICMs, and in those with a negative ST, a single-blind placebo controlled DPT was performed with the culprit. If ST or DPT were positive, then tolerance was assessed with an alternative negative ST ICM. We included 101 cases (12 IRs and 89 NIRs) confirmed as allergic. Among them, 36 (35.64%) cases were allergic to more than one ICM (8 IRs and 28 NIRs). The most common ICM involved were iomeprol and iodixanol. Although not statistically significant, the percentage of patients reporting anaphylaxis was higher in patients allergic to multiple ICMs compared with patients allergic to a single ICM (50 vs. 25%). Likewise, the percentage of positive results in STs was higher in patients allergic to multiple ICMs compared with those allergic to a single ICM (for IR 62.5 vs. 25%, p > 0.05; and for NIR, 85.71 vs. 24.59%, p < 0.000). In cases allergic to more than one ICM, DPT with negative-ST ICM was positive in more than 60% (24/36) of cases. Therefore, allergy to multiple ICMs is common, associated to severe reactions in IRs, and confirmed frequently by positive STs. The allergological work-up should include DPT not only to establish the diagnosis but also to identify safe alternative ICM, even if ICM is structurally unrelated and ST is negative. More studies are needed to clarify mechanisms underlying cross-reactivity among ICMs.

Dataset Information

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study.

Background

Methods

Findings

Publications

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study.

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