The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

IF 0.3 Q4 ALLERGY Astim Allerji Immunoloji Pub Date : 2021-08-23 DOI:10.21911/aai.606

Ozge Can Bostan, M. Çakmak, S. B. Kaya, E. Damadoğlu, G. Karakaya, A. Kalyoncu

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Abstract

ABSTRACT Objective: Controversies continue over the diagnostic approach, prediction, and premedication in radiocontrast media (RCM) hypersensitivity. One of the most important problems encountered in daily clinical practice is that patients do not recall which contrast agent has been used in previous exposures. Also, in most cases, the details of the reaction have not been recorded. Therefore, difficulties are experienced in decision-making about skin testing and premedication in patients who are suspected of RCM hypersensitivity. To assess the clinical value of skin tests and premedication in RCM hypersensitivity. Materials and Methods: A retrospective evaluation was made of the medical records of patients between October 2014 and December 2019. The skin tests were performed with the culprit agent if it was known, otherwise, with iohexol, one of the most commonly used RCM in Turkey. As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed. Results: A total of 41 patients were evaluated (32 females and 9 males). Of the reactions, 35 (85.4%) were immediate and 6 (14.6%) were non-immediate. Three (7.3%) had a positive intradermal test result. It was determined that 20 patients (17 immediate, 3 non- immediate), required imaging with RCM again. Of these, 18 received premedication and two did not, although it was recommended. Of the patients who received premedication, one (5.5%) had an urticarial reaction of the same grade, while both patients (100%) who did not receive premedication developed an immediate allergic reaction that was of a similar grade to that of the previous reaction. Conclusion: Skin test positivity for RCM was observed at low rates. In cases with negative skin tests and when the culprit drug cannot be identified, re-exposure to alternative RCM under premedication may reduce the risk of the reaction. Keywords: Allergy, iodinated contrast media, iobitridol, iohexol, premedication

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皮肤试验和用药前在放射性造影剂超敏反应中的作用：一个临床难题

摘要目的：关于放射性对照介质（RCM）超敏反应的诊断方法、预测和治疗前的争论仍在继续。在日常临床实践中遇到的最重要的问题之一是，患者不记得以前接触过哪种造影剂。此外，在大多数情况下，反应的细节没有被记录下来。因此，怀疑RCM超敏反应的患者在皮肤测试和用药前的决策方面遇到了困难。评估皮肤试验和术前用药在RCM超敏反应中的临床价值。材料和方法：对2014年10月至2019年12月期间患者的病历进行回顾性评价。皮肤测试是用罪魁祸首进行的，如果已知的话，用碘海醇进行，碘海醇是土耳其最常用的RCM之一。作为术前用药，术前13-7-1小时口服甲基强的松龙40 mg，术前1小时口服哌那敏22.7 mg。结果：共评估了41名患者（32名女性和9名男性）。在反应中，35例（85.4%）为立即反应，6例（14.6%）为非立即反应。其中3例（7.3%）皮内试验结果呈阳性。已确定20名患者（17名立即，3名非立即）需要再次进行RCM成像。其中，18人接受了术前治疗，2人没有接受，尽管这是推荐的。在接受术前治疗的患者中，一名（5.5%）出现了相同级别的荨麻疹反应，而两名未接受术前药物治疗的患者（100%）都出现了与先前反应相似级别的即时过敏反应。结论：RCM皮肤试验阳性率较低。在皮肤测试呈阴性的情况下，当无法确定罪魁祸首药物时，在术前再次接触替代RCM可能会降低反应风险。关键词：变态反应，碘造影剂，碘必妥醇，碘己醇，用药前

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Astim Allerji Immunoloji ALLERGY-

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期刊介绍： Asthma Allergy Immunology has been published three times a year in April, August and December as the official and periodical journal of the Turkish National Society of Allergy and Clinical Immunology since 2003. All articles published in the journal have been available online since 2003. A peer reviewed system is used in evaluation of the manuscripts submitted to Asthma Allergy Immunology. The official language of the journal is English. The aim of the journal is to present advances in the field of allergic diseases and clinical immunology to the readers. In accordance with this goal, manuscripts in the format of original research, review, case report, articles about clinical and practical applications and editorials, short report and letters to the editor about allergic diseases and clinical immunology are published in the journal. The target reader population of the Asthma Allergy Immunology includes specialists and residents of allergy and clinical immunology, pulmonology, internal medicine, pediatrics, dermatology and otolaryngology as well as physicians working in other fields of medicine interested in allergy and immunological diseases.

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