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

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