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

2018; Elsevier BV; Volume: 1; Linguagem: Inglês

10.1016/j.eclinm.2018.07.002

2589-5370

Olivier Clémеnt, Pascale Dewachter, Claudie Mouton‐Faivre, Camille Nevoret, L. Guilloux, Evelyne Bloch Morot, Sandrine Katsahian, D. Laroche, M Audebert, Béatrice Benabes-Jezraoui, Yves Benoit, S. Béot, F. Bérard, Yves Berthezène, P Bertrand, Juliette Bouffard, J.L. Bourrain, Bruno Boyer, Marie‐France Carette, C Caron-Poitreau, B. Cavestri, Jean–Pierre Cercueil, Denis-André Charpin, Evelyne Collet, Arielle Crombé-Ternamian, Jacques Dalmas, E. Decoux, Marie-France Defrance, Y. Delaval, P. Démoly, C. Depriester, Pascale Depriester, A. Didier, M. Drouet, B. Dupas, Dominique Dupre-Goetchebeur, C. Dzviga, Christine Fabre, G. Ferretti, Corinne Fourre-Jullian, P. Girardin, J. Giron, M. Gouitaa, Nicolas Grenier, Lydie Guenard Bilbault, S. Guez, Nathalie Gunera-Saad, Jean-François Heautot, Dominique Herbin, Cyrille Hoarau, C. Jacquot, Christian Julien, Laurent Laborie, Claude Lambert, P. Larroche, X. Leclerc, Laurent Lemaitre, F Leynadier, Agnés Lillo‐Le Louët, J Louvel, N. Louvier, Marie-Madeleine Lucas, Geneviève Meites, Nicolas Mennesson, Liliane Metge, Yannick Meunier, Laurence Monnier‐Cholley, M. Musacchio, B. Nicolie, Gisèle Occelli, Hélène Oesterle, Francine Paisant-Thouveny, M. Panuel, N. Railhac, Frédérique Rety-Jacob, C. Rochefort‐Morel, Catherine F. Roy, P. Sarliève, Musa Sesay, Catherine Sgro, P. Taourel, Patrick Terrier, Odile Theissen, Ingrid Topenot, J. Valfrey, F. Veillon, M Vergnaud, C Veyret, Vincent Denis, B. Wallaert, F. Wessel, Marc Zins,

Mast cells and histamine

BackgroundIodinated 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.MethodsPatients 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.FindingsAmong 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 < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups.InterpretationAllergic IH accounted for 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.