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Skin Test-Guided Strategy to Select Alternative Iodinated Contrast Media in Patients With Immediate Hypersensitivity Reaction: A Prospective Confirmative Study

Authors
 Ji-Hyang Lee  ;  Youngsang Yoo  ;  Sung-Ryeol Kim  ;  Jae-Hyun Lee  ;  Seo-Young Kim  ;  Jin An  ;  So-Young Park  ;  Han-Ki Park  ;  Sujeong Kim  ;  Woo-Jung Song  ;  Min-Suk Yang  ;  Hyouk-Soo Kwon  ;  Hye-Kyung Park  ;  Jaechun Lee  ;  Gyu-Young Hur  ;  Gang-Jee Ko  ;  Sang-Heon Kim  ;  Sae-Hoon Kim  ;  Young-Min Ye  ;  Young-Il Koh  ;  Byung-Jae Lee  ;  You Sook Cho  ;  Hwan Seok Yong  ;  Tae-Bum Kim 
Citation
 JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol.11(11) : 3454-3462.e1., 2023-11 
Journal Title
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
ISSN
 2213-2198 
Issue Date
2023-11
MeSH
Contrast Media / adverse effects ; Drug Hypersensitivity* / etiology ; Drug-Related Side Effects and Adverse Reactions* ; Humans ; Hypersensitivity* / complications ; Hypersensitivity, Immediate* / chemically induced ; Iodine Compounds* / adverse effects ; Prospective Studies ; Skin Tests / adverse effects
Keywords
Immediate hypersensitivity reaction ; Intradermal skin test ; Iodinated contrast media ; Prevention
Abstract
BACKGROUND: Iodinated contrast media (ICM) are a common cause of drug-induced immediate hypersensitivity reaction (IHR). Repeated use of ICM is often necessary; therefore, a standardized protocol to prevent recurrence of IHR is required.OBJECTIVE: We aimed to propose an intradermal skin test (IDT)-guided strategy for previous reactors to prevent recurrence of IHR.METHODS: We conducted a prospective multicenter study from May 2018 to December 2020 and recruited patients who had experienced IHR to ICM. Once enrolled, the participants underwent IDT with a causative ICM. The alternatives for reexposure were selected using the following protocol: (1) if the IDT with the culprit ICM was positive, further skin tests with other available ICM were conducted to choose IDT-negative agents as alternatives, and (2) if the IDT with the culprit ICM was negative, a randomly changed ICM was used without additional skin tests. The recurrence and severity of hypersensitivity were assessed in subsequent computed tomography examinations. Premedication was administered according to the severity of the index event in all cases.RESULTS: A total of 496 participants were enrolled, and 299 were reexposed to ICM. Among 269 participants who followed the protocol, 228 (84.8%) completed computed tomography examinations without adverse reactions, and IHR recurred in 16 of 30 participants (53.3%) who did not follow the protocol (P < .001). In addition, application of the protocol reduced the severity of IHR in recurred cases (P [ 0.003).CONCLUSIONS: Our IDT-guided strategy not only reduced recurrence of IHR to ICM but also mitigated the severity in recurred cases. This provides evidence for recommending an IDT to diagnose ICM allergy and find safe alternatives.(c) 2023 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2023;11:3454-62)
Full Text
https://www.sciencedirect.com/science/article/pii/S2213219823007754
DOI
10.1016/j.jaip.2023.07.004
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Ryeol(김성렬) ORCID logo https://orcid.org/0000-0001-7418-0049
Lee, Jae Hyun(이재현) ORCID logo https://orcid.org/0000-0002-0760-0071
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197968
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