Introduction:

Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice.

Methods:

A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM.

Results:

Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM.

Conclusion:

In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

中文翻译：

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通过皮肤试验和激发试验评估即时和非即时超敏反应对比反应：综述

介绍：

对含碘造影剂 (ICM) 和含钆造影剂的过敏性和非过敏性超敏反应分别分类为即刻或非即刻超敏反应（IHR 和 NIHR）。建议使用皮肤试验和激发试验来评估对造影剂的超敏反应；然而，挑衅在临床实践中并不常见。

方法：

进行 MEDLINE 搜索以调查包括皮肤试验和激发试验的研究，以评估对 ICM 的超敏反应。

结果：

确定了 19 项研究报告了皮肤测试，然后是刺激。在 IHR 到 ICM 的情况下，65/69 (94%) 的罪魁祸首介质皮试阳性患者耐受了皮试阴性替代 ICM 的挑战。在 IHR 到 ICM 中，罪魁祸首的皮肤试验为阴性，3.2%–9.1% 的患者的挑衅为阳性。在皮试呈阳性的 NIHR 到 ICM 的情况下，75/105 (71%) 的病例可以耐受皮试呈阴性的刺激。在 NIHR 中，罪魁祸首皮肤试验为阴性，再次暴露于罪魁祸首或替代物的患者中，0%–34.6% 的患者呈阳性。在 IHR 或 NIHR 的皮肤试验阳性患者中使用相同 ICM 的激发对大多数患者来说是阳性的，尽管很少进行这种激发试验。超敏反应数据，使用钆对比剂进行的皮肤测试和刺激是有限的；然而，它们表现出类似于在 ICM 中观察到的模式。

结论：

在 ICM 和基于钆的造影剂中，当皮试为阴性时，立即重复反应的风险很低。相比之下，使用皮试阳性造影剂的刺激表现出立即重复超敏反应的高风险。因此，需要详细的病史，然后进行皮肤测试。当诊断不确定时，建议进行刺激以进行诊断检查。