Contrast media hypersensitivity

Kvedariene V, Martins P. Rouanet L. Demoly P Diagnosis of iodinated contrast media hypersensitivity results of a 6-year period. Clin Exp Allergy 2006 36 1072-1077. 

Prior interleukin-2 therapy can induce atypical contrast medium hypersensitivity in the form of toxic recall reactions of various types (SEDA-17, 537), and these cannot be prevented by glucocorticoid premedication (315). 

Immediate hypersensitivity reactions to RCM are associated with histamine release from basophils and mast cells [27], and extensive mast cell activation in vivo associated with clinical symptoms has been demonstrated by Earoche et al. [31]. Patients with hypersensitivity reactions after contrast medium exposure had increased plasma levels of both histamine and tryptase, and levels correlated with severity. Also other investigators have reported high levels of tryptase in connection with severe or fatal reactions [21, 33]. 

Courvoisier S. Bircher AJ Delayed-type hypersensitivity to a nonionic, radiopaque contrast medium. Allergy 1998 53 1221-1224. 

Erdmann S, Roos T, Merk HF, Grussendorf-Conen Eli, Rubben A, Dahl T. Delayed hypersensitivity reaction to the non-ionic contrast medium ioversol. H G Z Hautkr 2000 75 169-71. 

Risk factors for a late skin reaction following administration of an iodinated contrast medium include current and up to 2 years past treatment with interleukin-2 (IL-2), a history of drug allergy or contact hypersensitivity, and a history of reaction to a previous contrast medium. Late reactions are more conunon in patients who reacted previously, especially if the same contrast medium is administered (see below). The latter fact is interesting since it suggests that the mechanism of the late reaction with its demonstration of memory may be immunologically and, in particular, T cell mediated. 

The authors of the Emopean multicenter study pointed out some limitations in their report. These included lack of provocation testing, the need for more control subjects exposed to a contrast medium but without clinical signs of a hypersensitivity reaction, the culprit drug was not... 

Katzberg RW Acute reactions to urographic contrast medium incidence, clinical characteristics, and relationship to history of hypersensitivity states - a commentary. AJR Am J Roentgenol 2008 190 1431-1432. 

Bohm I, Alike H, Klose KJ Hypersensitivity reactions and contrast medium injection are they always related Eur J Radiol 2011 80 368-372. 

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