Search

Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%‐3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re‐exposition or drug provocation test should only be done with skin test‐negative ICMs. The decision for performing either re‐exposition or drug provocation test needs to be taken based on a risk‐benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial. [ABSTRACT FROM AUTHOR]

Abbreviations AGEP acute generalized exanthematous pustulosis BAT basophil activation test CI cross-intolerant CSU chronic spontaneous urticarial DIHS/DRESS drug-induced hypersensitivity syndrome/drug reaction eosinophilia and systemic symptoms FDE fixed drug eruption LTT lymphocyte transformation test MPE maculopapular exanthema NECD exacerbated cutaneous disease NERD NSAIDs-exacerbated respiratory disease NIUA NSAIDs-induced urticaria/angioedema NSAIDs nonsteroidal anti-inflammatory drugs SJS Steven-Johnson syndrome SNIDHRs single-NSAID-induced delayed hypersensitivity reactions SNIUAA single-NSAID-induced urticaria/angioedema and anaphylaxis SR selective responders TEN toxic epidermal necrolysis Diagnosis in suspected hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) is complex as different mechanisms are involved: specific (selective responders, SRs) and nonspecific immunologically mediated (cross-intolerants, CIs) [[1], [3]] (Table). Patients with repeated episodes to >=3 different NSAIDs, including a strong COX-1 inhibitor, may be diagnosed as CIs.[4] The symptomatology after NSAIDs intake and the underlying diseases lead to their precise diagnosis: NSAIDs-exacerbated respiratory disease (NERD), NSAIDs-exacerbated cutaneous disease (NECD), NSAIDs-induced urticaria/angioedema (NIUA), and blended reactions (Figure, Table).[[1], [5]] If <3 episodes to different NSAIDs are reported, challenge tests are recommended to confirm/exclude the CI diagnosis; except if reactions involve airways in patients with underlying chronic respiratory disorders in which NERD diagnosis can be made by clinical history without performing challenge.[6] After diagnosis confirmation, a challenge to find a safe alternative is required (Figure). In vitro tests for drug hypersensitivity reactions: an ENDA/EAACI drug allergy interest group position paper. [Extracted from the article]