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A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions

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Abstract

The terms “immediate” and “delayed” adverse reactions induced by contrast media (CM) refer to the reactions' onset but do not provide substantial information concerning the clinical manifestation, the potential risk factors, the treatment modalities, or prevention. Because a variety of different reactions caused by different pathophysiological mechanisms may arise immediately or be delayed after CM injection, and because these need different management, the aim of the present paper is to present the clinical features and to exactly characterize lesser-known cutaneous reactions. A thorough knowledge of the clinical features, their adequate treatment, and, possibly, the subsequent diagnostic procedure for preventing recurrence after reexposure to CM would improve patient management.

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References

  1. Morcos SK, Thomsen HS (2001) Adverse reactions to iodinated contrast media. Eur Radiol 11(7):1267–1275

    Article  PubMed  CAS  Google Scholar 

  2. Thomsen HS, Morcos SK, Contrast Media Safety Committee of European Society of Urogenital Radiology (2004) Management of acute adverse reactions to contrast media. Eur Radiol 14:476–481

    Article  PubMed  Google Scholar 

  3. Morcos SK (2005) Acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol 78:686–693

    Article  PubMed  CAS  Google Scholar 

  4. Webb JA, Stacul F, Thomsen HS, Morcos SK, members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology (2003) Late adverse reactions to intravascular iodinated contrast media. Eur Radiol 13(1):181–184

    PubMed  Google Scholar 

  5. Christiansen C, Pichler WJ, Skotland T (2000) Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations. Eur Radiol 10:1965–1975

    Article  PubMed  CAS  Google Scholar 

  6. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K (1990) Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 175:621–628

    PubMed  CAS  Google Scholar 

  7. No authors listed G (1996) Delayed allergy-like reactions to X-ray contrast media. Exploration of the problem. Eur Radiol 6(5 Suppl):1–24

    Article  PubMed  Google Scholar 

  8. Pohly JP (1998) Onset of late adverse drug reactions to dimeric non-ionic contrast media: iotrolan, iodixanol. Pharmacoepidemiol Drug Saf 7(Suppl 1):S18–S22

    Article  PubMed  CAS  Google Scholar 

  9. Dooley M, Jarvis B (2000) Iomeprol: a review of its use as a contrast medium. Drugs 59:1169–1186

    Article  PubMed  CAS  Google Scholar 

  10. Muth CP, Henseke P, Grynne BH (1997) Iopentol (Imagopaque) in vascular procedures. A multi-centre monitoring trial assessing adverse events and diagnostic information-results from 3,587 patients in Germany. Eur Radiol 7(Suppl 4):S104–S108

    Article  PubMed  Google Scholar 

  11. Doerfler A, Fiebach J, Wanke I, Forsting M, Henseke P, Sartor K (1999) Iodixanol in cerebral computed tomography: a randomized, double-blind, phase-III, parallel study with iodixanol and iohexol. Eur Radiol 9:1362–1365

    Article  PubMed  CAS  Google Scholar 

  12. Federle MP, Chezmar JL, Rubin DL, Weinreb JC, Freeny PC, Semelka RC, Brown JJ, Borello JA, Lee JK, Mattrey R, Dachman AH, Saini S, Harmon B, Fenstermacher M, Pelsang RE, Harms SE, Mitchell DG, Halford HH, Anderson MW, Johnson CD, Francis IR, Bova JG, Kenney PJ, Klippenstein DL, Foster GS, Turner DA (2000) Safety and efficacy of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. multicenter phase III clinical trials (safety). J Magn Reson Imaging 12:186–197

    Article  PubMed  CAS  Google Scholar 

  13. Wang C, Gordon PB, Hustvedt SO, Grant D, Sterud AT, Martinsen I, Ahlstrom H, Hemmingsson A (1997) MR imaging properties and pharmacokinetics of MnDPDP in healthy volunteers. Acta Radiol 38:665–676

    PubMed  CAS  Google Scholar 

  14. Kim SH, Cho JY, Lim HK (1999) CT findings of isolated small bowel angioedema due to iodinated radiographic contrast medium reaction. Abdom Imaging 24:117–119

    Article  PubMed  CAS  Google Scholar 

  15. Bennasr S, Magnier S, Hassan M, Jacqz-Aigrain E (1994) Anaphylactic shock and low osmolarity contrast medium. Arch Pediatr 1:155–157

    PubMed  CAS  Google Scholar 

  16. Lieberman P, Siegle RL, Kaplan RJ, Hashimoto K (1976) Chronic urticaria and intermittent anaphylaxis. Reactions to lophendylate. JAMA 236:1495–1497

    Article  PubMed  CAS  Google Scholar 

  17. Laroche D, Namour F, Lefrancois C, Aimone-Gastin I, Romano A, Sainte-Laudy J, Laxenaire MC, Gueant JL (1999) Anaphylactoid and anaphylactic reactions to iodinated contrast material. Allergy Suppl 58:13–16

    Article  Google Scholar 

  18. Laroche D, Aimone-Gastin I, Dubois F, Huet H, Gerard P, Vergnaud MC, Mouton-Faivre C, Gueant JL, Laxenaire MC, Bricard H (1998) Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology 209:183–190

    PubMed  CAS  Google Scholar 

  19. Kurabayashi T, Ida M, Fukayama H, Ohbayashi N, Yoshino N, Sasaki T (1998) Adverse reactions to nonionic iodine in contrast-enhanced computed tomography: usefulness of monitoring vital signs. Dentomaxillofac Radiol 27:199–202

    Article  PubMed  CAS  Google Scholar 

  20. Bendel, Hoogland PH (1984) Quincke oedema following intrathecal administration of metrizamide. Neuroradiology 26:415–416

    Article  PubMed  CAS  Google Scholar 

  21. Ekholm S, Jonsson E, Sandvik L, Fagerlund M, Holtas S, Isberg B, Lindell D, Linden B, Sjoberg S, Thuomas KA, Tollesson PO (1996) Tolerance and efficacy of Omniscan (gadodiamide injection) in MR imaging of the central nervous system. Acta Radiol 37:223–228

    PubMed  CAS  Google Scholar 

  22. Seiderer M (1992) Phase III clinical studies with gadoteridol for the evaluation of neurologic pathology. A European perspective. Invest Radiol 27(Suppl 1):S33–S38

    PubMed  Google Scholar 

  23. Murphy KJ, Brunberg JA, Cohan RH (1996) Adverse reactions to gadolinium contrast media: a review of 36 cases. AJR Am J Roentgenol 167:847–849

    PubMed  CAS  Google Scholar 

  24. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wuthrich B, EAACI (the European Academy of Allergology and Clinical Immunology) Nomenclature Task Force (2001) A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 56:813–824

    Article  PubMed  CAS  Google Scholar 

  25. Miyauchi T, Hirano T, Ushiyama C, Ovary Z, Okumura K, Katayama H (1996) Anaphylactic IgE and IgG1 production for hapten can be enhanced by contrast media. Br J Radiol 69:920–924

    Article  PubMed  CAS  Google Scholar 

  26. Hoffmeister HM, Heller W (1996) Radiographic contrast media and the coagulation and complement systems. Invest Radiol 31(9):591–595

    Article  PubMed  CAS  Google Scholar 

  27. Lasser EC, Lang JH, Lyon SG, Hamblin AE (1980) Changes in complement and coagulation factors in a patient suffering a severe anaphylactoid reaction to injected contrast material: some considerations of pathogenesis. Invest Radiol 15(6 Suppl):S6–S12

    Article  PubMed  CAS  Google Scholar 

  28. Böhm I, Speck U, Schild H (2005) A possible role for cysteinyl-leukotrienes in non-ionic contrast media induced adverse reactions. Eur J Radiol 55:431–436

    Article  PubMed  Google Scholar 

  29. Goss JE, Chambers CE, Heupler FA Jr (1995) Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis, and treatment. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions. Cathet Cardiovasc Diagn 34:99–104

    Article  PubMed  CAS  Google Scholar 

  30. Morcos SK, Thomsen HS, Webb JA; Contrast Media Safety Committee of the European Society of Urogenital Radiology (2001) Prevention of generalized reactions to contrast media: a consensus report and guidelines. Eur Radiol 11:1720–1728

    Article  PubMed  CAS  Google Scholar 

  31. Ring J, Rothenberger KH, Clauss W (1985) Prevention of anaphylactoid reactions after radiographic contrast media infusion by combined histamine H1- and H2-receptor antagonists: results of a prospective controlled trial. Int Arch Allergy Appl Immunol 78:9–14

    PubMed  CAS  Google Scholar 

  32. Gall H, Pillekamp H, Peter RU (1999) Late-type allergy to the X-ray contrast medium Solutrast (iopamidol). Contact Dermatitis 40:248–250

    Article  PubMed  CAS  Google Scholar 

  33. Brockow K, Kiehn M, Kleinheinz A, Vieluf D, Ring J (1999) Positive skin tests in late reactions to radiographic contrast media. Allerg Immunol (Paris) 31:49–51

    CAS  Google Scholar 

  34. Courvoisier S, Bircher AJ (1998) Delayed-type hypersensitivity to a nonionic, radiopaque contrast medium. Allergy 53:1221–1224

    Article  PubMed  CAS  Google Scholar 

  35. Brockow K (2005) Contrast media hypersensitivity-scope of the problem. Toxicology 209:189–192

    Article  PubMed  CAS  Google Scholar 

  36. Kanny G, Pichler W, Morisset M, Franck P, Marie B, Kohler C, Renaudin JM, Beaudouin E, Laudy JS, Moneret-Vautrin DA (2005) T cell-mediated reactions to iodinated contrast media: evaluation by skin and lymphocyte activation tests. J Allergy Clin Immunol 115:179–185

    Article  PubMed  CAS  Google Scholar 

  37. Brockow K, Kiehn M, Kleinheinz A, Vieluf D, Ring J (1999) Positive skin tests in late reactions to radiographic contrast media. Allerg Immunol (Paris) 31:49–51

    CAS  Google Scholar 

  38. Barbaud A (2005) Drug patch testing in systemic cutaneous drug allergy. Toxicology 209:209–216

    Article  PubMed  CAS  Google Scholar 

  39. Vernassiere C, Trechot P, Commun N, Schmutz JL, Barbaud A (2004) Low negative predictive value of skin tests in investigating delayed reactions to radio-contrast media. Contact Dermatitis 50:359–366

    Article  PubMed  CAS  Google Scholar 

  40. Savill JS, Barrie R, Ghosh S, Muhlemann M, Dawson P, Pusey CD (1988) Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus. Postgrad Med J 64:392–394

    Article  PubMed  CAS  Google Scholar 

  41. Ghislain PD, Roujeau JC (2002) Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J 8:5

    PubMed  Google Scholar 

  42. Lee ML, Chiu IS (2002) Toxic epidermal necrolysis incriminating iopamidol in a child after cardiac catheterization. Int J Cardiol 82:95–97

    Article  PubMed  Google Scholar 

  43. Wood BP, Lane AT, Rabinowitz R (1988) Cutaneous reaction to contrast material. Radiology 169:739–740

    PubMed  CAS  Google Scholar 

  44. Laffitte E, Nenadov Beck M, Hofer M, Hohl D, Panizzon RG (2004) Severe Stevens-Johnson syndrome induced by contrast medium iopentol (Imagopaque). Br J Dermatol 150:376–378

    Article  PubMed  CAS  Google Scholar 

  45. Rosado A, Canto G, Veleiro B, Rodriguez J (2001) Toxic epidermal necrolysis after repeated injections of iohexol. AJR Am J Roentgenol 176:262–263

    PubMed  CAS  Google Scholar 

  46. Schmidt BJ, Foley WD, Bohorfoush AG (1998) Toxic epidermal necrolysis related to oral administration of diluted diatrizoate meglumine and diatrizoate sodium. AJR Am J Roentgenol 171:1215–1216

    PubMed  CAS  Google Scholar 

  47. Kaftori JK, Abraham Z, Gilhar A (1988) Toxic epidermal necrolysis after excretory pyelography. Immunologic-mediated contrast medium reaction? Int J Dermatol 27:346–347

    Article  PubMed  CAS  Google Scholar 

  48. Sadi AM, Toda T, Kiyuna M, Tamamoto T, Ohshiro K, Shinzato R (1995) An autopsy case of malignant lymphoma with Lyell’s syndrome. J Dermatol 22:594–599

    PubMed  CAS  Google Scholar 

  49. Friedmann PS, Strickland I, Pirmohamed M, Park BK (1994) Investigation of mechanisms in toxic epidermal necrolysis induced by carbamazepine. Arch Dermatol 130:598–604

    Article  PubMed  CAS  Google Scholar 

  50. Inachi S, Mizutani H, Shimizu M (1997) Epidermal apoptotic cell death in erythema multiforme and Stevens-Johnson syndrome. Contribution of perforin-positive cell infiltration. Arch Dermatol 133:845–849

    Article  PubMed  CAS  Google Scholar 

  51. Schnyder B, Frutig K, Mauri-Hellweg D, Limat A, Yawalkar N, Pichler WJ (1998) T-cell-mediated cytotoxicity against keratinocytes in sulfamethoxazol-induced skin reaction. Clin Exp Allergy 28:1412–1417

    Article  PubMed  CAS  Google Scholar 

  52. Correia O, Delgado L, Ramos JP, Resende C, Torrinha JA (1993) Cutaneous T-cell recruitment in toxic epidermal necrolysis. Further evidence of CD8+ lymphocyte involvement. Arch Dermatol 129:466–468

    Article  PubMed  CAS  Google Scholar 

  53. Bagot M, Charue D, Heslan M, Wechsler J, Roujeau JC, Revuz J (1993) Impaired antigen presentation in toxic epidermal necrolysis. Arch Dermatol 129:721–727

    Article  PubMed  CAS  Google Scholar 

  54. Leyva L, Torres MJ, Posadas S, Blanca M, Besso G, O’Valle F, del Moral RG, Santamar LF, Ju C (2000) Anticonvulsant-induced toxic epidermal necrolysis: monitoring the immunologic response. J Allergy Clin Immunol 105:157–165

    Article  PubMed  CAS  Google Scholar 

  55. Paquet P, Paquet F, Al Saleh W, Reper P, Vanderkelen A, Pierard GE (2000) Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Am J Dermatopathol 22:413–417

    Article  PubMed  CAS  Google Scholar 

  56. Le Cleach L, Delaire S, Boumsell L, Bagot M, Bourgault-Villada I, Bensussan A, Roujeau JC (2000) Blister fluid T lymphocytes during toxic epidermal necrolysis are functional cytotoxic cells which express human natural killer (NK) inhibitory receptors. Clin Exp Immunol 119:225–230

    Article  PubMed  Google Scholar 

  57. Paquet P, Pierard GE (1997) Erythema multiforme and toxic epidermal necrolysis: a comparative study. Am J Dermatopathol 19:127–132

    Article  PubMed  CAS  Google Scholar 

  58. Akiyama M, Iijima M, Fujisawa R (1990) Clinical analysis of drug eruption due to iohexol (Omnipaque). Nippon Hifuka Gakkai Zasshi 100:1057–1060

    PubMed  CAS  Google Scholar 

  59. Benson PM, Giblin WJ, Douglas DM (1990) Transient, nonpigmenting fixed drug eruption caused by radiopaque contrast media. J Am Acad Dermatol 23:379–381

    Article  PubMed  CAS  Google Scholar 

  60. Asano S, Ikeda M, Ichikawa E, Okabe S, Kawamura T, Maeda M (1990) Drug eruption due to iohexol (Omnipaque). Rinsho Hoshasen 35:533–536

    PubMed  CAS  Google Scholar 

  61. Good AE, Novak E, Sonda LP (1980) Fixed eruption and fever after urography. South Med J 73:948–949

    PubMed  CAS  Google Scholar 

  62. Yamauchi R, Morita A, Tsuji T (1997) Fixed drug eruption caused by iopamidol, a contrast medium. J Dermatol 24:243–245

    PubMed  CAS  Google Scholar 

  63. Watanabe H, Sueki H, Nakada T, Akiyama M, Iijima M (1999) Multiple fixed drug eruption caused by iomeprol (Iomeron), a nonionic contrast medium. Dermatology 198:291–294

    Article  PubMed  CAS  Google Scholar 

  64. Teraki Y, Moriya N, Shiohara T (1994) Drug-induced expression of intercellular adhesion molecule-1 on lesional keratinocytes in fixed drug eruption. Am J Pathol 145:550–560

    PubMed  CAS  Google Scholar 

  65. Boudoulas O, Siegle RJ, Grimwood RE (1987) Iododerma occurring after orally administered iopanoic acid. Arch Dermatol 123:387–388

    Article  PubMed  CAS  Google Scholar 

  66. Heydenreich G, Larsen PO (1977) Iododerma after high dose urography in an oliguric patient. Br J Dermatol 97:567–569

    Article  PubMed  CAS  Google Scholar 

  67. Vaillant L, Pengloan J, Blanchier D, De Muret A, Lorette G (1990) Iododerma and acute respiratory distress with leucocytoclastic vasculitis following the intravenous injection of contrast medium. Clin Exp Dermatol 15:232–233

    Article  PubMed  CAS  Google Scholar 

  68. Miranda-Romero A, Sanchez-Sambucety P, Esquivias Gomez JI, Martinez Fernandez M, Bajo del Pozo C, Aragoneses Fraile H, Garcia-Munoz M (1999) Vegetating iododerma with fatal outcome. Dermatology 198:295–297

    Article  PubMed  CAS  Google Scholar 

  69. Sparrow GP (1979) Iododerma due to radiographic contrast medium. J R Soc Med 72:60–61

    PubMed  CAS  Google Scholar 

  70. Chang MW, Miner JE, Moiin A, Hashimoto K (1997) Iododerma after computed tomographic scan with intravenous radiopaque contrast media. J Am Acad Dermatol 36:1014–1016

    Article  PubMed  CAS  Google Scholar 

  71. Fransson SG, Stenport G, Andersson M (1996) Immediate and late adverse reactions in coronary angiography. A comparison between iodixanol and ioxaglate. Acta Radiol 37:218–222

    PubMed  CAS  Google Scholar 

  72. Hosoya T, Yamaguchi K, Akutsu T, Mitsuhashi Y, Kondo S, Sugai Y, Adachi M (2000) Delayed adverse reactions to iodinated contrast media and their risk factors. Radiat Med 18:39–45

    PubMed  CAS  Google Scholar 

  73. Rydberg J, Charles J, Aspelin P (1998) Frequency of late allergy-like adverse reactions following injection of intravascular non-ionic contrast media. A retrospective study comparing a non-ionic monomeric contrast medium with a non-ionic dimeric contrast medium. Acta Radiol 39:219–222

    Article  PubMed  CAS  Google Scholar 

  74. Kanzaki T, Sakagami H (1991) Late phase allergic reaction to a CT contrast medium (iotrolan). J Dermatol 18:528–531

    PubMed  CAS  Google Scholar 

  75. Sutton AG, Finn P, Grech ED, Hall JA, Stewart MJ, Davies A, de Belder MA (2001) Early and late reactions after the use of iopamidol 340, ioxaglate 320, and iodixanol 320 in cardiac catheterization. Am Heart J 141:677–683

    Article  PubMed  CAS  Google Scholar 

  76. Orasch CE, Helbling A, Zanni MP, Yawalkar N, Hari Y, Pichler WJ (1999) T-cell reaction to local anaesthetics: relationship to angioedema and urticaria after subcutaneous application-patch testing and LTT in patients with adverse reaction to local anaesthetics. Clin Exp Allergy 29:1549–1554

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Radiology, University of Bonn, Sigmund-Freud Strasse 25, 53105, Bonn, Germany

    Ingrid Böhm & Hans H. Schild

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  1. Ingrid Böhm
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Correspondence to Ingrid Böhm.

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Böhm, I., Schild, H.H. A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions. Eur Radiol 16, 1570–1579 (2006). https://doi.org/10.1007/s00330-006-0202-9

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