조영제 사용 전 피부반응검사 후 발생한 조영제 과민반응의 발생 빈도와 임상 양상
Prevalence and clinical features of hypersensitivity reaction to contrast media after prescreening skin test
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Purpose: Hypersensitivity reactions to contrast media (CM) are one of the most common causes of drug adverse reactions. The overall prevalence of immediate hypersensitivity reaction (IHR) was 0.16%–7.7% to nonionic CM. Although IHR to CM has been traditionally considered nonallergic, there is growing evidence that the mechanism of IHR to CM is mediated by IgE. It can be severe, even fatal, and a legal problem. To reduce IHR, the prescreening skin test is on the rise. Methods: We reviewed cases of IHR to CM during enhanced computed tomography (CT) from 2008 to 2015 at a secondary hospital in South Korea. Patients who underwent enhanced CT were performed the 2-step prescreening skin test before nonionic CM-enhanced CT. If patients had adverse reactions to CM, the reactions were reported. IHR to CM was defined as an immediate reaction within 1 hour after CM administration. The Ring and Messmer system was used to classify the severity of reactions by grades I to IV, and we defined grades III and IV as severe reactions. Results: A total of 30,105 CM-enhanced CT cases were recruited from 2008 to 2015. A total 46 patients with CM adverse reactions were reported. The IHR were noted in 30 of the total patients (0.1%), of which 6 had severe reaction. Conclusion: The prevalences of IHR and severe IHR to CM were 0.1% and 0.02%, respectively. Further studies are needed to evaluate the usefulness of prescreening skin tests to prevent IHR to CM.
Abstract
Purpose: Hypersensitivity reactions to contrast media (CM) are one of the most common causes of drug adverse reactions. The overall prevalence of immediate hypersensitivity reaction (IHR) was 0.16%–7.7% to nonionic CM. Although IHR to CM has been traditionally considered nonallergic, there is growing evidence that the mechanism of IHR to CM is mediated by IgE. It can be severe, even fatal, and a legal problem. To reduce IHR, the prescreening skin test is on the rise. Methods: We reviewed cases of IHR to CM during enhanced computed tomography (CT) from 2008 to 2015 at a secondary hospital in South Korea. Patients who underwent enhanced CT were performed the 2-step prescreening skin test before nonionic CM-enhanced CT. If patients had adverse reactions to CM, the reactions were reported. IHR to CM was defined as an immediate reaction within 1 hour after CM administration. The Ring and Messmer system was used to classify the severity of reactions by grades I to IV, and we defined grades III and IV as severe reactions. Results: A total of 30,105 CM-enhanced CT cases were recruited from 2008 to 2015. A total 46 patients with CM adverse reactions were reported. The IHR were noted in 30 of the total patients (0.1%), of which 6 had severe reaction. Conclusion: The prevalences of IHR and severe IHR to CM were 0.1% and 0.02%, respectively. Further studies are needed to evaluate the usefulness of prescreening skin tests to prevent IHR to CM.
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