Online ISSN: 2149-3189
2015
Monthly
Nicaea Medical Publishing
Türkiye

Risk Assessment and Skin Test Outcomes in Contrast Media Hypersensitivity: A Single-Center Study

Filiz Sadi Aykan, Fatih Çölkesen, Mehmet Kılınç, Recep Evcen, Eray Yıldız, Ferhat Sağun, Şevket Arslan
  • Filiz Sadi Aykan (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0002-8941-5573
  • Fatih Çölkesen (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye https://orcid.org/0000-0002-6595-1267
  • Mehmet Kılınç (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, Batman Training and Research Hospital, Batman, Türkiye https://orcid.org/0000-0003-1117-6872
  • Recep Evcen (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Türkiye https://orcid.org/0000-0002-6124-5816
  • Eray Yıldız (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, Necip Fazıl City Hospital, Kahramanmaraş, Türkiye https://orcid.org/0000-0002-9596-1773
  • Ferhat Sağun (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye https://orcid.org/0000-0003-3752-8469
  • Şevket Arslan (Author) Department of Internal Medicine, Division of Clinical Immunology and Allergy, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye https://orcid.org/0000-0002-0343-0159
DOI
https://doi.org/10.18621/eurj.1798798
Abstract
Objectives: Contrast media can cause adverse reactions ranging from mild skin symptoms to anaphylaxis. Although the pathophysiology is not fully understood, various risk factors have been reported. This study aimed to evaluate the risk factors and skin tests in patients experiencing hypersensitivity reactions to contrast media.
Methods: A total of 52 patients were included in the study. Patients experiencing contrast media-induced hypersensitivity reactions were evaluated for demographic and clinical characteristics, the type of contrast media used, and skin tests. They were compared with patients without a history of reactions. The patient group experiencing reactions was further divided into two groups: those with and without atopic disease.
Results: The patient group experiencing reactions was older. Comorbidity was high, and cardiovascular disease was the most common. Reactions were most frequently immediate and grade 1 and 2 in severity. The skin was most commonly affected, and anaphylaxis was detected in 28.6%. Approximately one-third had comorbid atopic disease, and respiratory system diseases and Hashimoto's thyroiditis were significantly more common in this group. In the group without comorbid atopic disease, malignancy and psychiatric disorders were more common, but not significantly so. Skin tests were negative in all groups.
Conclusions: Hypersensitivity reactions related to contrast medium use are increasing. Unnecessary examinations and tests cause delays in patient follow-up and treatment. All physicians must recognize and appropriately manage patients and reactions at high risk for contrast medium-related hypersensitivity reactions. We believe our study will contribute to the literature in managing and raising awareness of these reactions.
Keywords
Contrast Media, Hypersensitivity, Atopy, Skin Test
References

1. Christiansen C. X-ray contrast media--an overview. Toxicology. 2005;209(2):185-187. doi: 10.1016/j.tox.2004.12.020.

2. Heshmatzadeh Behzadi A, Prince MR. Preventing Allergic Reactions to Gadolinium-Based Contrast Agents. Top Magn Reson Imaging. 2016;25(6):275-279. doi: 10.1097/RMR.0000000000000106.

3. Kim MH, Park CH, Kim DI, et al. Surveillance of contrast-media-induced hypersensitivity reactions using signals from an electronic medical recording system. Ann Allergy Asthma Immunol. 2012;108(3):167-171. doi: 10.1016/j.anai.2012.01.012.

4. Lee SY, Lim KW, Chang YS. Radiocontrast media hypersensitivity in the Asia Pacific region. Asia Pac Allergy. 2014;4(2):119-125. doi: 10.5415/apallergy.2014.4.2.119.

5. Brockow K, Christiansen C, Kanny G, et al; ENDA; EAACI interest group on drug hypersensitivity. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005;60(2):150-158. doi: 10.1111/j.1398-9995.2005.00745.x.

6. Brockow K, Sánchez-Borges M. Hypersensitivity to contrast media and dyes. Immunol Allergy Clin North Am. 2014;34(3):547-564, viii. doi: 10.1016/j.iac.2014.04.002.

7. Muraro A, Roberts G, Worm M, et al; EAACI Food Allergy and Anaphylaxis Guidelines Group. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026-1045. doi: 10.1111/all.12437.

8. Clement O, Dewachter P, Mouton-Faivre C, et al. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study. EClinicalMedicine. 2018;1:51-61. doi: 10.1016/j.eclinm.2018.07.002.

9. Yoon SH, Lee SY, Kang HR, et al. Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy. 2015;70(6):625-637. doi: 10.1111/all.12589.

10. Fok JS, Smith WB. Hypersensitivity reactions to gadolinium-based contrast agents. Curr Opin Allergy Clin Immunol. 2017;17(4):241-246. doi: 10.1097/ACI.0000000000000371.

11. Torres MJ, Gomez F, Doña I, et al. Diagnostic evaluation of patients with nonimmediate cutaneous hypersensitivity reactions to iodinated contrast media. Allergy. 2012;67(7):929-935. doi: 10.1111/j.1398-9995.2012.02840.x.

12. Bumbăcea RS, Petruţescu B, Bumbăcea D, Strâmbu I. Immediate and delayed hypersensitivity reactions to intravascular iodine based radiocontrast media -- an update. Pneumologia. 2013;62(1):47-51.

13. Goksel O, Aydın O, Atasoy C, et al. Hypersensitivity reactions to contrast media: prevalence, risk factors and the role of skin tests in diagnosis--a cross-sectional survey. Int Arch Allergy Immunol. 2011;155(3):297-305. doi: 10.1159/000320760.

14. Sánchez-Borges M, Aberer W, Brockow K, et al. Controversies in Drug Allergy: Radiographic Contrast Media. J Allergy Clin Immunol Pract. 2019;7(1):61-65. doi: 10.1016/j.jaip.2018.06.030.

15. Naisbitt DJ, Gordon SF, Pirmohamed M, Park BK. Immunological principles of adverse drug reactions: the initiation and propagation of immune responses elicited by drug treatment. Drug Saf. 2000;23(6):483-507. doi: 10.2165/00002018-200023060-00002.

16. Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1(8009):466-469. doi: 10.1016/s0140-6736(77)91953-5.

17. Aberer W, Bircher A, Romano A, et al; European Network for Drug Allergy (ENDA); EAACI interest group on drug hypersensitivity. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003;58(9):854-863. doi: 10.1034/j.1398-9995.2003.00279.x.

18. Prieto-García A, Tomás M, Pineda R, et al. Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing. J Investig Allergol Clin Immunol. 2013;23(3):183-189.

19. Schönmann C, Brockow K. Adverse reactions during procedures: Hypersensitivity to contrast agents and dyes. Ann Allergy Asthma Immunol. 2020;124(2):156-164. doi: 10.1016/j.anai.2019.11.022.

20. Webb JA, Stacul F, Thomsen HS, Morcos SK; Members of The Contrast Media Safety Committee Of The European Society of Urogenital Radiology. Late adverse reactions to intravascular iodinated contrast media. Eur Radiol. 2003;13(1):18118-4. doi: 10.1007/s00330-002-1650-5.

21. Newmark JL, Mehra A, Singla AK. Radiocontrast media allergic reactions and interventional pain practice--a review. Pain Physician. 2012;15(5):E665-675.

22. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175(3):621-628. doi: 10.1148/radiology.175.3.2343107.

23. Katayama H, Kozuka T, Ebata K. Assessment of the side-effects of iomeprol. Eur J Radiol. 1994;18 Suppl 1:S115-9. doi: 10.1016/0720-048x(94)90105-8.

24. Katayama H, Tanaka T. Clinical survey of adverse reactions to contrast media. Invest Radiol. 1988;23 Suppl 1:S88-9. doi: 10.1097/00004424-198809001-00005.

25. Pradubpongsa P, Dhana N, Jongjarearnprasert K, Janpanich S, Thongngarm T. Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome-the results of a 3-year period. Asian Pac J Allergy Immunol. 2013;31(4):299-306. doi: 10.12932/AP0297.31.4.2013.

26. Thomas M, Peedicayil J, Koshi T, Korah I. Adverse reactions to radiocontrast media in an Indian population. Br J Radiol. 1999;72(859):648-652. doi: 10.1259/bjr.72.859.10624321.

27. Lee SY, Kang DY, Kim JY, et al. Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System. J Investig Allergol Clin Immunol. 2019;29(6):444-450. doi: 10.18176/jiaci.0374.

28. Trcka J, Schmidt C, Seitz CS, Bröcker EB, Gross GE, Trautmann A. Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? AJR Am J Roentgenol. 2008;190(3):666-670. doi: 10.2214/AJR.07.2872.

29. Costantino MT, Romanini L, Gaeta F, et al. SIRM-SIAAIC consensus, an Italian document on management of patients at risk of hypersensitivity reactions to contrast media. Clin Mol Allergy. 2020;18:13. doi: 10.1186/s12948-020-00128-3.

30. Isola S, Furci F, Gangemi S. The involvement of osmolarity in the safety of contrast media. Clin Mol Allergy. 2018;16:19. doi: 10.1186/s12948-018-0097-4.

31. Chatani R, Kondo S, Kamimura T, et al. Exploring Factors Affecting the Occurrence of Hypersensitivity Reactions Induced by Nonionic Iodine Contrast Media. J Clin Pharmacol. 2023;63(9):1002-1008. doi: 10.1002/jcph.2256.

32. Nucera E, Parrinello G, Gangemi S, et al. Contrast Medium Hypersensitivity: A Large Italian Study with Long-Term Follow-Up. Biomedicines. 2022;10(4):759. doi: 10.3390/biomedicines10040759.

33. Torres MJ, Trautmann A, Böhm I, et al. Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity. Allergy. 2021;76(5):1325-1339. doi: 10.1111/all.14656.

34. Lang DM, Alpern MB, Visintainer PF, Smith ST. Increased risk for anaphylactoid reaction from contrast media in patients on beta-adrenergic blockers or with asthma. Ann Intern Med. 1991;115(4):270-276. doi: 10.7326/0003-4819-115-4-270.

35. Rottem M, Gershwin ME, Shoenfeld Y. Allergic disease and autoimmune effectors pathways. Dev Immunol. 2002;9(3):161-167. doi: 10.1080/1044667031000137638.

36. Sakamoto E, Katahira Y, Mizoguchi I, et al. Chemical- and Drug-Induced Allergic, Inflammatory, and Autoimmune Diseases Via Haptenation. Biology (Basel). 2023;12(1):123. doi: 10.3390/biology12010123.

37. Watanabe Y, Yamaguchi Y. Drug allergy and autoimmune diseases. Allergol Int. 2022;71(2):179-184. doi: 10.1016/j.alit.2022.02.001.

38. Khudair A, Khudair A, Niinuma SA, Habib H, Butler AE. Beyond thyroid dysfunction: the systemic impact of iodine excess. Front Endocrinol (Lausanne). 2025;16:1568807. doi: 10.3389/fendo.2025.1568807.

39. Lalli AF. Urographic contrast media reactions and anxiety. Radiology. 1974;112(2):267-271. doi: 10.1148/112.2.267.

40. Yasuda R, Munechika H. Delayed adverse reactions to nonionic monomeric contrast-enhanced media. Invest Radiol. 1998;33(1):1-5. doi: 10.1097/00004424-199801000-00001.

41. Tepetam FM, Çiftaslan N, Oruç Ö, et al. Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study. Radiol Med. 2016;121(8):660-666. doi: 10.1007/s11547-016-0646-1.

42. Brockow K. Contrast media hypersensitivity--scope of the problem. Toxicology. 2005;209(2):189-192. doi: 10.1016/j.tox.2004.12.032.

43. Brockow K, Romano A, Aberer W, et al; European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity. Skin testing in patients with hypersensitivity reactions to iodinated contrast media - a European multicenter study. Allergy. 2009;64(2):234-241. doi: 10.1111/j.1398-9995.2008.01832.x.

44. Kim SH, Jo EJ, Kim MY, et al. Clinical value of radiocontrast media skin tests as a prescreening and diagnostic tool in hypersensitivity reactions. Ann Allergy Asthma Immunol. 2013;110(4):258-262. doi: 10.1016/j.anai.2013.01.004.

There are 44 references in total.
How to Cite
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Sadi Aykan F, Çölkesen F, Kılınç M, et al. Risk Assessment and Skin Test Outcomes in Contrast Media Hypersensitivity: A Single-Center Study. Eur Res J. 2026;12(1):97-107. doi:10.18621/eurj.1798798
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