Side effects of contrast media – the current state of knowledge. Part 2. Risk factors, contraindications, premedication and diagnostic procedures
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Published:
Dec 24, 2017
Keywords:
contrast media, iodine, gadolinium, side effects
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Abstract
Paper presents the current state of knowledge on side effects of radiographic contrast media; both hypersensitivity and toxic reactions. Risk factors and contraindications are discussed. Authors refer to many published papers that discuss premedication and diagnostic procedures.
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Sadowska , B., & Lipiec, A. (2017). Side effects of contrast media – the current state of knowledge. Part 2. Risk factors, contraindications, premedication and diagnostic procedures. Alergoprofil, 13(4), 141-148. https://doi.org/10.24292/01.AP.231217
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
1. Andreucci M., Faga T., Pisani A. et al.: Review Article The Choice of the Iodinated Radiographic Contrast Media to Prevent Contrast-Induced Nephropathy. Advances in Nefrology 2014, 2014. DOI: 10.1155/2014/691623.
2. Andreucci M., Solomon R., Tasanarong A.: Side effects of radiographic contrast media: Pathogenesis, risk factors, and prevention. Biomed. Res. Int. 2014, 2014.
3. Brockow K., Christiansen C., Kanny G. et al.: Management of hypersensitivity reactions to iodinated contrast media. Allergy 2005, 60(2): 150-158.
4. ACR Committee M on CD and C. Manual on Contrast Media, v10.1., 2015 [online: http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/ContrastManual/2015_Contrast_Media.pdf].
5. Sadowska B., Lipiec A.: Reakcje niepożądane po zastosowaniu środków kontrastowych – aktualny stan wiedzy. Część 1. Charakterystyka środków kontrastowych, rodzaje i obraz kliniczny reakcji niepożądanych. Alergoprofil 2017, 13(1): 19-28.
6. Rosado Ingelmo A., Diaz D.I., Moreno C.R. et al.: Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media. J. Investig. Allergol. Clin. Immunol. 2016, 26(263): 144-155.
7. Egbert R.E., De Cecco C.N., Schoepf U.J. et al.: Delayed adverse reactions to the parenteral administration of iodinated contrast media. Am. J. Roentgenol. 2014, 203(6): 1163-1170.
8. Yamaguchi K., Katayama H., Takashima T. et al.: Prediction of severe adverse reactions to ionic and nonionic contrast-media in Japan – evaluation of pretesting – a report from the Japanese committee on the safety of contrast media. Radiology 1991, 178(2): 363-367.
9. Lang D.M., Alpern M.B., Visintainer P.F., Smith S.T.: Elevated risk of anaphylactoid reaction from radiographic contrast media is associated with both beta-blocker exposure and cardiovascular disorders. Arch. Intern. Med. 1993, 153(17): 2033-2040.
10. 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.
11. Davenport M.S., Cohan R.H., Caoili E.M., Ellis J.H.: Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology 2009, 253(2): 372-379.
12. Dillman J.R., Strouse P.J., Ellis J.H. et al.: Incidence and severity of acute allergic-like reactions to IV nonionic iodinated contrast material in children. Am. J. Roentgenol. 2007, 188(6): 1643-1647.
13. Kopp A.F., Mortele K.J., Cho Y.D. et al.: Prevalence of acute reactions to iopromide: postmarketing surveillance study of 74,717 patients. Acta Radiol. 2008, 49(8): 902-911.
14. Brockow K.: Contrast media hypersensitivity – scope of the problem. Toxicology 2005, 209: 189-192.
15. Bettmann M.A.: Frequently asked questions: iodinated contrast agents. Radiographics 2004, 24 Supl. 1: S3-S10.
16. Morcos S.K.: Acute serious and fatal reactions to contrast media: Our current understanding. Br. J. Radiol. 2005, 78(932): 686-693.
17. Webb J.A., Stacul F., Thomsen H.S., Morcos S.K.: Late adverse reactions to intravascular iodinated contrast media. Eur. Radiol. 2003, 13(1): 181-184.
18. Freed K.S., Leder R.A., Alexander C. et al.: Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. Am. J. Roentgenol. 2001, 176(6): 1389-1392.
19. Choyke P.L., Miller D.L., Lotze M.T. et al.: Delayed reactions to contrast media after interleukin-2 immunotherapy. Radiology 1992, 183(1): 111-114.
20. Murphy K., Brunberg J., Cohan R.: Adverse reactions to gadolinium contrast media: a review of 36 cases. Am. J. Roentgenol. 1996, 167(4): 847-849.
21. Brockow K., Romano A., Aberer W. et al.: Skin testing in patients with hypersensitivity reactions to iodinated contrast media – A European multicenter study. Allergy Eur. J. Allergy Clin. Immunol. 2009, 64(2): 234-241.
22. Coakley F.V., Panicek D.M.: Iodine allergy: an oyster without a pearl? Am. J. Roentgenol. 1997, 169: 951-952.
23. Jung J.W., Kang H.R., Kim M.H. et al.: Immediate hypersensitivity reaction to gadolinium-based MR contrast media. Radiology 2012, 264(2): 414-422.
24. Hunt C.H., Hartman R.P., Hesley G.K.: Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: Retrospective review of 456,930 doses. Am. J. Roentgenol. 2009, 193(4): 1124-1127.
25. Somashekar D.K., Davenport M.S., Cohan R.H. et al.: Effect of Intravenous Low-Osmolality Iodinated Contrast Media on Patients with Myasthenia Gravis. Radiology 2013, 267(3): 727-734.
26. Callahan M.J., Poznauskis L., Zurakowski D., Taylor G.A.: Nonionic Iodinated Intravenous Contrast Material-related Reactions: Incidence in Large Urban Children’s Hospital – Retrospective Analysis of Data in 12 494 Patients. Radiology 2009, 250(3): 674-681.
27. Ventura M.T., Calogiuri G.F., Matino M.G. et al.: Alternative glucocorticoids for use in cases of adverse reaction to systemic glucocorticoids: A study on 10 patients. Br. J. Dermatol. 2003, 148(1): 139-141.
28. Motosugi U., Ichikawa T., Sano K., Onishi H.: Acute Adverse Reactions to Nonionic Iodinated Contrast Media for CT: Prospective Randomized Evaluation of the Effects of Dehydration, Oral Rehydration, and Patient Risk Factors. Am. J. Roentgenol. 2016, 207(5): 931-938.
29. Davis P.L.: Anaphylactoid reactions to the nonvascular administration of water-soluble iodinated contrast media. Am. J. Roentgenol. 2015, 204(6): 1140-1145.
30. Jingu A, Fukuda J, Taketomi-Takahashi A, Tsushima Y. Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol. BMC Med. Imaging 2014, 14(1): 34.
31. Liccardi G., Lobefalo G., Di Florio E. et al.: Strategies for the prevention of asthmatic, anaphylactic and anaphylactoid reactions during the administration of anesthetics and/or contrast media. J. Investig. Allergol. Clin. Immunol. 2008, 18(1): 1-11.
32. Bumbacea R.S., Petrutescu B., Bumbacea D., Strambu I.: Immediate and delayed hypersensitivity reactions to intravascular iodine based radiocontrast media – an update. Pneumologia 2013, 62(1): 47-51.
33. Tramèr M.R., von Elm E., Loubeyre P., Hauser C.: Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ (Clinical Res ed). 2006, 333(7570): 675.
34. Lasser E.C., Berry C.C., Mishkin M.M. et al.: Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. Am. J. Roentgenol. 1994, 162(3): 523-529.
35. Greenberger P.A., Patterson R.: The prevention of immediate generalized reactions to radiocontrast media in high-risk patients. J. Allergy Clin. Immunol. 1991, 87(4): 867-872.
36. Brockow K.: Immediate and delayed cutaneous reactions to radiocontrast media. W: French L.E. (red.): Adverse Cutaneous Drug Eruptions. Chem. Immunol. Allergy. Basel, Karger 2012, 97: 180-190. 37. Kim S.H., Lee S.H., Lee S.M. et al.: Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur. J. Radiol. 2011, 80(2): 363-367.
38. Kolbe A.B., Hartman R.P., Hoskin T.L. et al.: Premedication of patients for prior urticarial reaction to iodinated contrast medium. Abdom. Imaging 2014, 39(2): 432-437.
39. Granata V., Cascella M., Fusco R. et al.: Immediate Adverse Reactions to Gadolinium-Based MR Contrast Media: A Retrospective Analysis on 10, 608 Examinations. 2016, 2016.
40. Dunsky E.H., Zweiman B., Fischler E., Levy D.A.: Early effects of corticosteroids on basophils, leukocyte histamine, and tissue histamine. J. Allergy Clin. Immunol. 1979, 63: 426-432.
41. Trout A.T., Dillman J.R., Ellis J.H. et al.: Patterns of intravenous contrast material use and corticosteroid premedication in children-a survey of Society of Chairs of Radiology in Children’s Hospitals (SCORCH) member institutions. Pediatr. Radiol. 2011, 41(10): 1272-1283.
42. Kim S.H., Jo E.J., Kim M.Y. 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.
43. Brockow K., Garvey L.H., Aberer W. et al.: Skin test concentrations for systemically administered drugs – An ENDA/EAACI Drug Allergy Interest Group position paper. Allergy Eur. J. Allergy Clin. Immunol. 2013, 68(6): 702-712.
44. Barbaud A.: Skin Testing and Patch Testing in Non-IgE-Mediated Drug Allergy. Curr. Allergy Asthma Rep. 2014, 14(6): 1-8.
45. Brockow K.: Immediate and Delayed Reactions to Radiocontrast Media: Is There an Allergic Mechanism? Immunol. Allergy Clin. North Am. 2009, 29(3): 453-468.
46. Yoon S.H., Lee S.Y., Kang H.R. et al.: Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy 2015, 70(6): 625-637.
47. Bellin M.F., Stacul F., Webb J.A.W. et al.: Late adverse reactions to intravascular iodine based contrast media: An update. Eur. Radiol. 2011, 21(11): 2305-2310.
48. Caimmi S., Benyahia B., Suau D. et al.: Clinical value of negative skin tests to iodinated contrast media Clinical & Experimental Allergy. Clin. Exp. Allergy 2010, (40): 805-810.
49. Salas M., Gomez F., Fernandez T.D. et al.: Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy Eur. J. Allergy Clin. Immunol. 2013, 68(9): 1203-1206.
50. Seitz C.S., Pfeuffer P., Raith P. et al.: Radiocontrast media-associated exanthema: Identification of cross reactivity and tolerability by allergologic testing. Eur. J. Radiol. 2009, 72(1): 167-171.
51. Chirumbolo S.: Basophil activation test (BAT) in the diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy Eur. J. Allergy Clin. Immunol. 2013, 68(12): 1627-1628.
52. Lerondeau B., Trechot P., Waton J. et al.: Analysis of cross-reactivity among radiocontrast media in 97 hypersensitivity reactions. J. Allergy Clin. Immunol. 2016, 137(2): 633-635.
53. Gomez E., Ariza A., Blanca-López N., Torres M.J.: Nonimmediate hypersensitivity reactions to iodinated contrast media. Curr. Opin. Allergy Clin. Immunol. 2013, 13(4): 345-353.
54. Meth M.J., Maibach H.I.: Current understanding of contrast media reactions and implications for clinical management. Drug Saf. 2006, 29(2): 133-141.
55. Kanny G., Pichler W., Morisset M. et al.: T cell-mediated reactions to iodinated contrast media: Evaluation by skin and lymphocyte activation tests. J. Allergy Clin. Immunol. 2005, 115(1): 179-185.
56. Pinnobphun P., Buranapraditkun S., Kampitak T. et al.: The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media. Ann. Allergy Asthma Immunol. 2011, 106(5): 387-393.
57. Lasser E.C.: Concentrated X-ray contrast media can act as universal antigen and can inhibit or prevent allergic reactions. United States Patent N0. US007151117B2, Date of Patent: Dec. 19 [online: www.patentimages.storage.googleapis.com/pdfs/US7151117.pdf].
2. Andreucci M., Solomon R., Tasanarong A.: Side effects of radiographic contrast media: Pathogenesis, risk factors, and prevention. Biomed. Res. Int. 2014, 2014.
3. Brockow K., Christiansen C., Kanny G. et al.: Management of hypersensitivity reactions to iodinated contrast media. Allergy 2005, 60(2): 150-158.
4. ACR Committee M on CD and C. Manual on Contrast Media, v10.1., 2015 [online: http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/ContrastManual/2015_Contrast_Media.pdf].
5. Sadowska B., Lipiec A.: Reakcje niepożądane po zastosowaniu środków kontrastowych – aktualny stan wiedzy. Część 1. Charakterystyka środków kontrastowych, rodzaje i obraz kliniczny reakcji niepożądanych. Alergoprofil 2017, 13(1): 19-28.
6. Rosado Ingelmo A., Diaz D.I., Moreno C.R. et al.: Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media. J. Investig. Allergol. Clin. Immunol. 2016, 26(263): 144-155.
7. Egbert R.E., De Cecco C.N., Schoepf U.J. et al.: Delayed adverse reactions to the parenteral administration of iodinated contrast media. Am. J. Roentgenol. 2014, 203(6): 1163-1170.
8. Yamaguchi K., Katayama H., Takashima T. et al.: Prediction of severe adverse reactions to ionic and nonionic contrast-media in Japan – evaluation of pretesting – a report from the Japanese committee on the safety of contrast media. Radiology 1991, 178(2): 363-367.
9. Lang D.M., Alpern M.B., Visintainer P.F., Smith S.T.: Elevated risk of anaphylactoid reaction from radiographic contrast media is associated with both beta-blocker exposure and cardiovascular disorders. Arch. Intern. Med. 1993, 153(17): 2033-2040.
10. 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.
11. Davenport M.S., Cohan R.H., Caoili E.M., Ellis J.H.: Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology 2009, 253(2): 372-379.
12. Dillman J.R., Strouse P.J., Ellis J.H. et al.: Incidence and severity of acute allergic-like reactions to IV nonionic iodinated contrast material in children. Am. J. Roentgenol. 2007, 188(6): 1643-1647.
13. Kopp A.F., Mortele K.J., Cho Y.D. et al.: Prevalence of acute reactions to iopromide: postmarketing surveillance study of 74,717 patients. Acta Radiol. 2008, 49(8): 902-911.
14. Brockow K.: Contrast media hypersensitivity – scope of the problem. Toxicology 2005, 209: 189-192.
15. Bettmann M.A.: Frequently asked questions: iodinated contrast agents. Radiographics 2004, 24 Supl. 1: S3-S10.
16. Morcos S.K.: Acute serious and fatal reactions to contrast media: Our current understanding. Br. J. Radiol. 2005, 78(932): 686-693.
17. Webb J.A., Stacul F., Thomsen H.S., Morcos S.K.: Late adverse reactions to intravascular iodinated contrast media. Eur. Radiol. 2003, 13(1): 181-184.
18. Freed K.S., Leder R.A., Alexander C. et al.: Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. Am. J. Roentgenol. 2001, 176(6): 1389-1392.
19. Choyke P.L., Miller D.L., Lotze M.T. et al.: Delayed reactions to contrast media after interleukin-2 immunotherapy. Radiology 1992, 183(1): 111-114.
20. Murphy K., Brunberg J., Cohan R.: Adverse reactions to gadolinium contrast media: a review of 36 cases. Am. J. Roentgenol. 1996, 167(4): 847-849.
21. Brockow K., Romano A., Aberer W. et al.: Skin testing in patients with hypersensitivity reactions to iodinated contrast media – A European multicenter study. Allergy Eur. J. Allergy Clin. Immunol. 2009, 64(2): 234-241.
22. Coakley F.V., Panicek D.M.: Iodine allergy: an oyster without a pearl? Am. J. Roentgenol. 1997, 169: 951-952.
23. Jung J.W., Kang H.R., Kim M.H. et al.: Immediate hypersensitivity reaction to gadolinium-based MR contrast media. Radiology 2012, 264(2): 414-422.
24. Hunt C.H., Hartman R.P., Hesley G.K.: Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: Retrospective review of 456,930 doses. Am. J. Roentgenol. 2009, 193(4): 1124-1127.
25. Somashekar D.K., Davenport M.S., Cohan R.H. et al.: Effect of Intravenous Low-Osmolality Iodinated Contrast Media on Patients with Myasthenia Gravis. Radiology 2013, 267(3): 727-734.
26. Callahan M.J., Poznauskis L., Zurakowski D., Taylor G.A.: Nonionic Iodinated Intravenous Contrast Material-related Reactions: Incidence in Large Urban Children’s Hospital – Retrospective Analysis of Data in 12 494 Patients. Radiology 2009, 250(3): 674-681.
27. Ventura M.T., Calogiuri G.F., Matino M.G. et al.: Alternative glucocorticoids for use in cases of adverse reaction to systemic glucocorticoids: A study on 10 patients. Br. J. Dermatol. 2003, 148(1): 139-141.
28. Motosugi U., Ichikawa T., Sano K., Onishi H.: Acute Adverse Reactions to Nonionic Iodinated Contrast Media for CT: Prospective Randomized Evaluation of the Effects of Dehydration, Oral Rehydration, and Patient Risk Factors. Am. J. Roentgenol. 2016, 207(5): 931-938.
29. Davis P.L.: Anaphylactoid reactions to the nonvascular administration of water-soluble iodinated contrast media. Am. J. Roentgenol. 2015, 204(6): 1140-1145.
30. Jingu A, Fukuda J, Taketomi-Takahashi A, Tsushima Y. Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol. BMC Med. Imaging 2014, 14(1): 34.
31. Liccardi G., Lobefalo G., Di Florio E. et al.: Strategies for the prevention of asthmatic, anaphylactic and anaphylactoid reactions during the administration of anesthetics and/or contrast media. J. Investig. Allergol. Clin. Immunol. 2008, 18(1): 1-11.
32. Bumbacea R.S., Petrutescu B., Bumbacea D., Strambu I.: Immediate and delayed hypersensitivity reactions to intravascular iodine based radiocontrast media – an update. Pneumologia 2013, 62(1): 47-51.
33. Tramèr M.R., von Elm E., Loubeyre P., Hauser C.: Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ (Clinical Res ed). 2006, 333(7570): 675.
34. Lasser E.C., Berry C.C., Mishkin M.M. et al.: Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. Am. J. Roentgenol. 1994, 162(3): 523-529.
35. Greenberger P.A., Patterson R.: The prevention of immediate generalized reactions to radiocontrast media in high-risk patients. J. Allergy Clin. Immunol. 1991, 87(4): 867-872.
36. Brockow K.: Immediate and delayed cutaneous reactions to radiocontrast media. W: French L.E. (red.): Adverse Cutaneous Drug Eruptions. Chem. Immunol. Allergy. Basel, Karger 2012, 97: 180-190. 37. Kim S.H., Lee S.H., Lee S.M. et al.: Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur. J. Radiol. 2011, 80(2): 363-367.
38. Kolbe A.B., Hartman R.P., Hoskin T.L. et al.: Premedication of patients for prior urticarial reaction to iodinated contrast medium. Abdom. Imaging 2014, 39(2): 432-437.
39. Granata V., Cascella M., Fusco R. et al.: Immediate Adverse Reactions to Gadolinium-Based MR Contrast Media: A Retrospective Analysis on 10, 608 Examinations. 2016, 2016.
40. Dunsky E.H., Zweiman B., Fischler E., Levy D.A.: Early effects of corticosteroids on basophils, leukocyte histamine, and tissue histamine. J. Allergy Clin. Immunol. 1979, 63: 426-432.
41. Trout A.T., Dillman J.R., Ellis J.H. et al.: Patterns of intravenous contrast material use and corticosteroid premedication in children-a survey of Society of Chairs of Radiology in Children’s Hospitals (SCORCH) member institutions. Pediatr. Radiol. 2011, 41(10): 1272-1283.
42. Kim S.H., Jo E.J., Kim M.Y. 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.
43. Brockow K., Garvey L.H., Aberer W. et al.: Skin test concentrations for systemically administered drugs – An ENDA/EAACI Drug Allergy Interest Group position paper. Allergy Eur. J. Allergy Clin. Immunol. 2013, 68(6): 702-712.
44. Barbaud A.: Skin Testing and Patch Testing in Non-IgE-Mediated Drug Allergy. Curr. Allergy Asthma Rep. 2014, 14(6): 1-8.
45. Brockow K.: Immediate and Delayed Reactions to Radiocontrast Media: Is There an Allergic Mechanism? Immunol. Allergy Clin. North Am. 2009, 29(3): 453-468.
46. Yoon S.H., Lee S.Y., Kang H.R. et al.: Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy 2015, 70(6): 625-637.
47. Bellin M.F., Stacul F., Webb J.A.W. et al.: Late adverse reactions to intravascular iodine based contrast media: An update. Eur. Radiol. 2011, 21(11): 2305-2310.
48. Caimmi S., Benyahia B., Suau D. et al.: Clinical value of negative skin tests to iodinated contrast media Clinical & Experimental Allergy. Clin. Exp. Allergy 2010, (40): 805-810.
49. Salas M., Gomez F., Fernandez T.D. et al.: Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy Eur. J. Allergy Clin. Immunol. 2013, 68(9): 1203-1206.
50. Seitz C.S., Pfeuffer P., Raith P. et al.: Radiocontrast media-associated exanthema: Identification of cross reactivity and tolerability by allergologic testing. Eur. J. Radiol. 2009, 72(1): 167-171.
51. Chirumbolo S.: Basophil activation test (BAT) in the diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy Eur. J. Allergy Clin. Immunol. 2013, 68(12): 1627-1628.
52. Lerondeau B., Trechot P., Waton J. et al.: Analysis of cross-reactivity among radiocontrast media in 97 hypersensitivity reactions. J. Allergy Clin. Immunol. 2016, 137(2): 633-635.
53. Gomez E., Ariza A., Blanca-López N., Torres M.J.: Nonimmediate hypersensitivity reactions to iodinated contrast media. Curr. Opin. Allergy Clin. Immunol. 2013, 13(4): 345-353.
54. Meth M.J., Maibach H.I.: Current understanding of contrast media reactions and implications for clinical management. Drug Saf. 2006, 29(2): 133-141.
55. Kanny G., Pichler W., Morisset M. et al.: T cell-mediated reactions to iodinated contrast media: Evaluation by skin and lymphocyte activation tests. J. Allergy Clin. Immunol. 2005, 115(1): 179-185.
56. Pinnobphun P., Buranapraditkun S., Kampitak T. et al.: The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media. Ann. Allergy Asthma Immunol. 2011, 106(5): 387-393.
57. Lasser E.C.: Concentrated X-ray contrast media can act as universal antigen and can inhibit or prevent allergic reactions. United States Patent N0. US007151117B2, Date of Patent: Dec. 19 [online: www.patentimages.storage.googleapis.com/pdfs/US7151117.pdf].