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Current Opinion in Allergy & Clinical Immunology:
doi: 10.1097/ACI.0b013e328362b926
DRUG ALLERGY: Edited by Miguel Blanca and Bernard Y.-H. Thong

Nonimmediate hypersensitivity reactions to iodinated contrast media

Gómez, Enriquea; Ariza, Adrianaa; Blanca-López, Nataliab; Torres, Maria J.c

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Abstract

Purpose of review

To provide a detailed analysis of the latest findings on the mechanisms underlying the nonimmediate reactions to iodinated contrast media and comment on the recent advances in diagnosis, focusing on the roles of the skin test, drug provocation test (DPT), and lymphocyte transformation test (LTT).

Recent findings

Several studies have reported new findings supporting an important role for T-lymphocytes in the nonimmediate reactions to iodinated contrast media. The LTT has been used as an in-vitro tool for diagnosis, but with variable results. However, the inclusion of autologous monocyte-derived dendritic cells as professional antigen-presenting cells has improved the sensitivity of this test. Regarding in-vivo diagnosis, although skin testing has been routine, it has now been shown that its sensitivity and negative predictive value are low. Recent studies have demonstrated that the DPT is a well tolerated and useful procedure that is necessary to confirm the diagnosis of nonimmediate hypersensitivity reactions to iodinated contrast media.

Summary

Nonimmediate reactions to contrast media are usually T-cell mediated. Diagnosis is based on skin testing, although its sensitivity and negative predictive value are not optimal. Consequently, drug provocation testing is often needed to confirm the diagnosis and also to seek alternative contrast media that can be tolerated.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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