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Immediate hypersensitivity to iodinated contrast media: diagnostic accuracy of skin tests and intravenous provocation test with low dose
Author(s) -
Sesé L.,
Gaouar H.,
Autegarden J.E.,
Alari A.,
Amsler E.,
VialDupuy A.,
Pecquet C.,
Francès C.,
Soria A.
Publication year - 2016
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.12703
Subject(s) - provocation test , medicine , iodinated contrast media , placebo , dermatology , hypersensitivity reaction , patch test , clinical significance , surgery , anesthesia , allergy , pathology , immunology , alternative medicine
Summary Background The diagnosis of HSR to iodinated contrast media ( ICM ) is challenging based on clinical history and skin tests. Objective This study evaluates the negative predictive value ( NPV ) of skin tests and intravenous provocation test ( IPT ) with low‐dose ICM in patients with suspected immediate hypersensitivity reaction ( HSR ) to ICM . Methods Thirty‐seven patients with suspected immediate hypersensitivity reaction to ICM were included retrospectively. Skin tests and a single‐blind placebo‐controlled intravenous provocation test ( IPT ) with low‐dose iodinated contrast media ( ICM ) were performed. Results Skin tests with ICM were positive in five cases (one skin prick test and five intradermal test). Thirty‐six patients were challenged successfully by IPT , and only one patient had a positive challenge result, with a grade I reaction by the Ring and Messmer classification. Ten of 23 patients followed up by telephone were re‐exposed to a negative tested ICM during radiologic examination; two experienced a grade I immediate reaction. Conclusions & Clinical Relevance For immediate hypersensitivity reaction to ICM , the NPV for skin tests and IPT with low dose was 80% (95% CI 44–97%).