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요오드화 조영제 과민반응에 대한 임상 대처 최신 지견

Recent updates of iodinated contrast media hypersensitivity

강혜련|이서영|조민경
대한 소아알레르기 호흡기학회 (The Korean Academy Of Pediatric Allergy And Respiratory Disease)|2020.07|Allergy Asthma & Respiratory Disease (알레르기 천식 호흡기질환)|제8권 제3호|pp. 107-113|DOI https://doi.org/10.4168/aard.2020.8.3.107

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참고문헌

키워드

Contrast mediaSecondary preventionSkin testsImmediate hypersensitivity
주제분류소아과학

초록

1Drug Safety Monitoring Center, Seoul National University Hospital, Seoul; 2Department of Internal Medicine, Seoul National University Hospital, Seoul; 3Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea Previously, immediate reactions to ionic high-osmolar iodinated contrast media (ICM) were regarded as nonimmunological. However, despite the use of lower-osmolar ICM, ICM hypersensitivity still occurs in some patients and recent studies suggest that there would be a true allergic response, especially in more severe form. Currently, it is important to identify the sensitized ICM and avoid the agent; however, the usefulness of skin tests and challenge tests has not yet been established, since there are few large-scale studies on them. Although, skin test-negative ICM can be safely used in clinical practice, conflicting results have been reported through various studies, depending on the challenge protocols used. Therefore, standard protocols need to provided. Even if a culprit agent is not proven by skin tests, its use should be avoided. Reuse of contrast media increases the risk of occurrence of hypersensitivity reactions. For patients with previous hypersensitivity reactions to contrast media, premedication can help prevent recurrence, but breakthrough in hypersensitivity is not fully achieved by premedication, especially when the previous reaction was a severe form such as anaphylaxis. Therefore, it is necessary to establish an optimal strategy to choose alternative ICM and premedication protocols to prevent recurrence of hypersensitivity reactions to nonionic contrast media.

Abstract

1Drug Safety Monitoring Center, Seoul National University Hospital, Seoul; 2Department of Internal Medicine, Seoul National University Hospital, Seoul; 3Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea Previously, immediate reactions to ionic high-osmolar iodinated contrast media (ICM) were regarded as nonimmunological. However, despite the use of lower-osmolar ICM, ICM hypersensitivity still occurs in some patients and recent studies suggest that there would be a true allergic response, especially in more severe form. Currently, it is important to identify the sensitized ICM and avoid the agent; however, the usefulness of skin tests and challenge tests has not yet been established, since there are few large-scale studies on them. Although, skin test-negative ICM can be safely used in clinical practice, conflicting results have been reported through various studies, depending on the challenge protocols used. Therefore, standard protocols need to provided. Even if a culprit agent is not proven by skin tests, its use should be avoided. Reuse of contrast media increases the risk of occurrence of hypersensitivity reactions. For patients with previous hypersensitivity reactions to contrast media, premedication can help prevent recurrence, but breakthrough in hypersensitivity is not fully achieved by premedication, especially when the previous reaction was a severe form such as anaphylaxis. Therefore, it is necessary to establish an optimal strategy to choose alternative ICM and premedication protocols to prevent recurrence of hypersensitivity reactions to nonionic contrast media.

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