CM Hypersensitivity Reactions

Hypersensitivity reaction to iodinated contrast media Thatchai Kampitak 20 May 2009

Scope ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Introduction ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

Iodinated contrast media ,[object Object],[object Object],[object Object],[object Object],Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81

Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81

Christensen C In Pichler WJ Drug hypersensitivity 2007

Pharmacokinetic ,[object Object],[object Object],[object Object],[object Object],Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Brockow K et al. Allergy 2005;60:150-8

Immediate hypersensitivity reaction

Prevalence ,[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Clinical manifestations ,[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8 Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81 Christensen C In Pichler WJ Drug hypersensitivity 2007

Risk factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8

Szebeni J. Curr Allergy Asthma Rep 2004;4:25-30

Chemotoxic effect ,[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Osmolality ,[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Complement activation ,[object Object],[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

IgE-mediated mechanism Idee JM et al. Fundam Clin Pharmacol 2005;19:263-81

Diagnosis ,[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8

Skin test was positive in 50% of patients who were skin tested within 2-6 months Specificity of skin test was 96.3% 32 (26%) (4 by SPT, 30 by IDT) 122 Brockow K et al (Allergy 2009) BAT was positive in 3 patients 4 (4%) by IDT 96 Trcka J et al (Am J Roentgenol 2008) Median time to skin test was 3 and 48 months in positive and negative skin test patients (p <0.05) Respiratory allergy was more frequent in the positive skin test patient 9 (28%) (1 by SPT, 8 by IDT) 32 Kvedariene V et al (Clin Exp Allergy 2006) 9.3% cross-reactivity rate 19 (73%) by IDT 26 Laroche D et al (Contrast Mol Med Imaging 2006) Note Positive results Number of patients References

[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object],[object Object],Christensen C. in Pichler WJ Drug hypersensitivity 2007

Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8

[object Object],[object Object],[object Object],[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72 Christensen C. in Pichler WJ Drug hypersensitivity 2007

Delayed hypersensitivity reaction

Prevalence ,[object Object],[object Object],[object Object],[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8

Risk factors ,[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

[object Object],Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

[object Object],[object Object],[object Object],[object Object]

Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],Brockow K et al. Allergy 2005;60:150-8 Gueant-Rodriguez RM et al. Curr Pharm Des 2006;12:3359-72

Conclusion ,[object Object],[object Object],[object Object]

CM Hypersensitivity Reactions

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CM Hypersensitivity Reactions