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Current Treatment Options in Allergy

, Volume 5, Issue 1, pp 103–117 | Cite as

Hypersensitivity Reactions to Iodinated Contrast Media: Is it a True Allergy?

  • Esther Moreno
  • M. Teresa Gracia-Bara
  • Cristobalina Mayorga
  • Milagros Lázaro
  • M. Valle Campanón
  • Ignacio Dávila
Drug Allergy (MJ Torres Jaén, Section Editor)

Opinion statement

Classically, hypersensitivity reactions to iodinated contrast media (ICM) have been termed pseudoallergic, allergy-like, or anaphylactoid. The origin of these terms to define ICM hypersensitivity reactions could be in relation to the use of traditional, classic, ionic ICMs. These ionic ICMs have a high osmolality, and the reactions have been considered as secondary to non-specific histamine release. Currently, ionic ICMs have been replaced by non-ionic compounds with low or iso-osmolality, which, although to a lesser extent, can also produce hypersensitivity reactions. In recent years, there has been growing evidence that some of these reactions, especially the more severe, can be triggered by an IgE-dependent mechanism. Also, in recent decades, there has been an increase in non-immediate reactions, especially in the form of maculopapular exanthems occurring up to several days after the administration of ICM. In these non-immediate reactions, the involvement of T lymphocytes has been clearly demonstrated. The finding of positive skin tests and other in vitro studies for ICMs would support a specific immunological mechanism in a percentage of ICM-induced reactions. However, although there is a body of evidence suggesting that ICMs can induce true allergy reactions, the main guidelines for contrast media management, such as those proposed by US (American College of Radiology Manual on Contrast Media) or European (European Society of Urogenital Radiology Guidelines on Contrast Media) societies, continue to consider only immediate reactions and handle them as non-allergic reactions, without any allergy testing. In ICM reactions an allergic evaluation should be mandatory, not only to study the possible mechanisms involved but also to identify the ICM involved in the reaction and to find an alternative one that could be used in future radiological explorations.

Keywords

Hypersensitivity Iodinated contrast media Skin tests Drug provocation tests Basophil activation tests 

Notes

Funding Information

The present study has been supported by the Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Regional Development Fund (ERDF): RETICs ARADyAL (RD16/0006/0001; RD16/0006/0033; RD16/0006/0019).

Compliance with Ethical Standards

Conflict of Interest

Esther Moreno declares that she has no conflict of interest. M. Teresa Gracia-Bara declares the she has no conflict of interest. Cristobalina Mayorga declares the she has no conflict of interest. Milagros Lázaro declares the she has no conflict of interest. M. Valle Campanón declares the she has no conflict of interest. Ignacio Dávila declares the he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Esther Moreno
    • 1
    • 2
    • 3
  • M. Teresa Gracia-Bara
    • 1
    • 2
  • Cristobalina Mayorga
    • 4
    • 5
  • Milagros Lázaro
    • 1
  • M. Valle Campanón
    • 1
  • Ignacio Dávila
    • 1
    • 2
    • 3
  1. 1.Allergy ServiceUniversity Hospital of SalamancaSalamancaSpain
  2. 2.Department of Biomedical and Diagnostics Sciences, Faculty of MedicineUniversity of SalamancaSalamancaSpain
  3. 3.Institute for Biomedical Research of Salamanca (IBSAL)SalamancaSpain
  4. 4.Research LaboratoryIBIMA—Regional University Hospital of Malaga—UMAMálagaSpain
  5. 5.Allergy UnitIBIMA—Regional University Hospital of Malaga—UMAMálagaSpain

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