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. 2018 Jul 28:1:51-61.
doi: 10.1016/j.eclinm.2018.07.002. eCollection 2018 Jul.

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

Olivier Clement  1   2 , Pascale Dewachter  3 , Claudie Mouton-Faivre  4 , Camille Nevoret  5 , Laurence Guilloux  6 , Evelyne Bloch Morot  7 , Sandrine Katsahian  8 , Dominique Laroche  9   10 ; investigators of the CIRTACI study; Martine Audebert  11 , Béatrice Benabes-Jezraoui  12 , Yves Benoit  13 , Sylvie Beot  14 , Frédéric Berard  15 , Yves Berthezene  16 , Philippe Bertrand  17 , Juliette Bouffard  18 , Jean-Luc Bourrain  19 , Bruno Boyer  20 , Marie-France Carette  21 , Christine Caron-Poitreau  22 , Béatrice Cavestri  23 , Jean Pierre Cercueil  24 , Denis-André Charpin  25 , Evelyne Collet  26 , Arielle Crombe-Ternamian  27 , Jacques Dalmas  28 , Eric Decoux  29 , Marie-France Defrance  30 , Yvonne Delaval  31 , Pascal Demoly  32 , Claude Depriester  33 , Pascale Depriester  11 , Alain Didier  34 , Martine Drouet  35 , Benoît Dupas  36 , Dominique Dupre-Goetchebeur  37 , Charles Dzviga  38 , Christine Fabre  39 , Gilbert Ferretti  40 , Corinne Fourre-Jullian  41 , Pascal Girardin  42 , Jacques Giron  43 , Marion Gouitaa  25 , Nicolas Grenier  44 , Lydie Guenard Bilbault  45 , Stéphane Guez  46 , Nathalie Gunera-Saad  47 , Jean-François Heautot  48 , Dominique Herbin  49 , Cyrille Hoarau  50 , Claude Jacquot  51 , Christian Julien  52 , Laurent Laborie  53 , Claude Lambert  54 , Pascal Larroche  55 , Xavier Leclerc  56 , Laurent Lemaitre  57 , Francisque Leynadier  21 , Agnès Lillo-Le-Louet  58 , Jean-Pierre Louvel  59 , Nathalie Louvier  60 , Marie-Madeleine Lucas  31 , Geneviève Meites  61 , Nicolas Mennesson  27 , Liliane Metge  62 , Yannick Meunier  63 , Laurence Monnier-Cholley  64 , Mariano Musacchio  65 , Brigitte Nicolie  66 , Gisèle Occelli  67 , Hélène Oesterle  65 , Francine Paisant-Thouveny  68 , Michel Panuel  69 , Nadine Railhac  70 , Frédérique Rety-Jacob  18 , Cécile Rochefort-Morel  31 , Catherine Roy  71 , Philippe Sarlieve  72 , Musa Sesay  73 , Catherine Sgro  74 , Patrice Taourel  75 , Patrick Terrier  76 , Odile Theissen  77 , Ingrid Topenot  78 , Jocelyne Valfrey  79 , Francis Veillon  80 , Marie-Claude Vergnaud  81 , Charles Veyret  38 , Denis Vincent  82 , Benoit Wallaert  83 , François Wessel  84 , Marc Zins  30
Affiliations

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

Olivier Clement et al. EClinicalMedicine. .

Abstract

Background: Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.

Methods: Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.

Findings: Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups.

Interpretation: Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

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Figures

Fig. 1
Fig. 1
Flow chart and description of the study cohort. Severity grades were evaluated according to the Ring and Messmer scale . CM: contrast material
Fig. 2
Fig. 2
Number of cases of allergic (black bars) or non-allergic (light gray bars) immediate hypersensitivity according to the severity grade of the reaction. Potentially allergic group is represented in dark gray. ICM: iodinated contrast material; GBCM: gadolinium-based contrast material. The severity grade was determined according to the Ring and Messmer scale .
Fig. 3
Fig. 3
Plasma concentrations of histamine (upper panel) and tryptase (lower panel) within the first two hours after the immediate hypersensitivity reaction, according to the severity grade of Allergic, Potentially Allergic, and Non-allergic reactions (logarithmic scale). The severity grade was determined according to the Ring and Messmer scale .
See this image and copyright information in PMC

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