Cross-reactivity among iodinated contrast agents: should we be concerned?

Adrian A Schmid; John N Morelli; Martin N Hungerbühler; Ingrid B Boehm

doi:10.21037/qims-20-1325

Cross-reactivity among iodinated contrast agents: should we be concerned?

Quant Imaging Med Surg. 2021 Sep;11(9):4028-4041. doi: 10.21037/qims-20-1325.

Authors

Adrian A Schmid¹, John N Morelli², Martin N Hungerbühler³, Ingrid B Boehm³

Affiliations

¹ Department of Orthopaedics and Traumatology, Spital Altstaetten, Altstaetten, Switzerland.
² Department of Radiology, St. John's Medical Center Tulsa, OK, USA.
³ Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.

Abstract

Background: Although several papers deal with "cross-reactivity" in patients with iodinated contrast medium (ICM) hypersensitivity reactions (HSRs), there is no in-depth knowledge of this phenomenon. To define ICM-groups as potential reaction partners and to identify any potential clinical relevance in patients with ICM-HSRs.

Methods: The literature database PubMed was searched for eligible papers dealing with ICM-allergy and "cross-reactivity". The data presented by the papers was analyzed and individual patient data was extracted for re-evaluation based on a definition for both 'polyvalent reactivity' and 'cross-reactivity' as well as for chemical structure-dependent ICM-groups.

Results: Twenty-five original papers (with n=340 extracted patients) formed the study population. Incidences of polyvalent reactivity were non-significantly higher than incidences of cross-reactivity (both range from 0% to 100%). Crossover evaluation in reaction pairings (culprit ICM A with ICM B versus culprit ICM B with ICM A) showed concordance of only 30%. Data support rather non-cross-reactivity (individual reaction pattern) than cross-reactivity constellations.

Conclusions: The obtained results favour an individual reaction pattern, rather than a reactivity driven by chemical structures and so-called cross-reactivity.

Keywords: Cross-reactivity; drug provocation test (DPT); hypersensitivity reaction (HSR); immediate reaction (IR); iodinated contrast medium (ICM); non-immediate reaction (NIR); polyvalent reactions; risk stratification.