Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

Olivier Clément; Pascale Dewachter; Claudie Mouton-Faivre; Camille Nevoret; Laurence Guilloux; Evelyne Bloch Morot; Sandrine Katsahian; Dominique Laroche; Martine Audebert; Béatrice Benabes-Jezraoui; Yves Benoit; Sylvie Beot; Frédéric Bérard; Yves Berthezène; Philippe Bertrand; Juliette Bouffard; Jean-Luc Bourrain; Bruno Boyer; Marie-France Carette; Christine Caron-Poitreau; Béatrice Cavestri; Jean Pierre Cercueil; Denis-André Charpin; Evelyne Collet; Arielle Crombe-Ternamian; Jacques Dalmas; Eric Decoux; Marie-France Defrance; Yvonne Delaval; Pascal Demoly; Claude Depriester; Pascale Depriester; Alain Didier; Martine Drouet; Benoît Dupas; Dominique Dupre-Goetchebeur; Charles Dzviga; Christine Fabre; Gilbert R. Ferretti; Corinne Fourre-Jullian; Pascal Girardin; Jacques Giron; Marion Gouitaa; Nicolas Grenier; Lydie Guenard Bilbault; Stéphane Guez; Nathalie Gunera-Saad; Jean-François Heautot; Dominique Herbin; Cyrille Hoarau; Claude Jacquot; Christian Julien; Laurent Laborie; Claude Lambert; Pascal Larroche; Xavier Leclerc; Laurent Lemaître; Francisque Leynadier; Agnès Lillo-Le-Louet; Jean-Pierre Louvel; Nathalie Louvier; Marie-Madeleine Lucas; Geneviève Meites; Nicolas Mennesson; Liliane Metge; Yannick Meunier; Laurence Monnier-Cholley; Mariano Musacchio; Brigitte Nicolie; Gisèle Occelli; Hélène Oesterle; Francine Paisant-Thouveny; Michel Panuel; Nadine Railhac; Frédérique Rety-Jacob; Cécile Rochefort-Morel; Catherine Roy; Philippe Sarlieve; Musa Sesay; Catherine Sgro; Patrice Taourel; Patrick Terrier; Odile Theissen; Ingrid Topenot; Jocelyne Valfrey; Francis Veillon; Marie-Claude Vergnaud; Charles Veyret; Denis Vincent; Benoit Wallaert; François Wessel; Marc Zins

doi:10.1016/j.eclinm.2018.07.002

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Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

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Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

Olivier Clément, Pascale Dewachter, Claudie Mouton-Faivre, Camille Nevoret, Laurence Guilloux, Evelyne Bloch Morot, Sandrine Katsahian, Dominique Laroche, Martine Audebert, Béatrice Benabes-Jezraoui, …

EClinicalMedicine, Vol.1, pp.51-61

07/2018

DOI: https://doi.org/10.1016/j.eclinm.2018.07.002

PMCID: PMC6537532

PMID: 31193689

Abstract

Background:Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.Methods:Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.Findings:Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups.Interpretation:Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

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Title: Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study
Creators - without role: Olivier Clément - Service de Radiologie [CHU HEGP]
Pascale Dewachter - Sorbonne Paris Cité
Claudie Mouton-Faivre - Centre Hospitalier Régional Universitaire de Nancy
Camille Nevoret - Hôpital Européen
Laurence Guilloux - Biomnis Laboratory
Evelyne Bloch Morot - Service de Médecine Interne [CHU HEGP]
Sandrine Katsahian - Hôpital Européen
Dominique Laroche - Université de Caen Normandie
Martine Audebert - Centre Hospitalier Universitaire Amiens-Picardie
Béatrice Benabes-Jezraoui - Hôpital Nord
Yves Benoit - Hôpital Edouard Herriot
Sylvie Beot - Centre Hospitalier Régional et Universitaire de Nancy
Frédéric Bérard - Hôpital Lyon Sud
Yves Berthezène - Hôpital de la Croix-Rousse
Philippe Bertrand - Centre Hospitalier Universitaire de Tours
Juliette Bouffard - Hôpital Lyon Sud
Jean-Luc Bourrain - Centre Hospitalier Universitaire de Grenoble
Bruno Boyer - Délégation Centre-Est
Marie-France Carette - Charmo University
Christine Caron-Poitreau - Centre Hospitalier Universitaire d'Angers
Béatrice Cavestri - Hôpital Albert Calmette
Jean Pierre Cercueil - Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon)
Denis-André Charpin - Hôpital Nord
Evelyne Collet - Centre Hospitalier Universitaire Dijon Bourgogne
Arielle Crombe-Ternamian - Hôpital Edouard Herriot
Jacques Dalmas - CH Martigues
Eric Decoux - Hôpital Lapeyronie
Marie-France Defrance - Hôpital Saint Joseph
Yvonne Delaval - Hôpital Pontchaillou
Pascal Demoly - Hôpital Arnaud de Villeneuve
Claude Depriester
Pascale Depriester - Centre Hospitalier Universitaire Amiens-Picardie
Alain Didier - Hôpital Larrey
Martine Drouet - Centre Hospitalier Universitaire d'Angers
Benoît Dupas - Centre Hospitalier Universitaire de Nantes
Dominique Dupre-Goetchebeur - Centre Hospitalier Régional Universitaire de Brest
Charles Dzviga - Hôpital Nord
Christine Fabre - Centre Hospitalier Universitaire de Nîmes
Gilbert R. Ferretti - Imagerie Médicale et Radiothérapie Drôme Ardèche
Corinne Fourre-Jullian - Université de Reims Champagne-Ardenne
Pascal Girardin - Hôpital Saint-Jacques
Jacques Giron - Hôpital Purpan
Marion Gouitaa - Hôpital Nord
Nicolas Grenier - Hôpital Pellegrin
Lydie Guenard Bilbault - Centre Hospitalier Régional Universitaire de Nancy
Stéphane Guez - Hôpital Pellegrin
Nathalie Gunera-Saad
Jean-François Heautot - Hôpital Pontchaillou
Dominique Herbin - Centre Hospitalier de Versailles
Cyrille Hoarau - Centre Hospitalier Universitaire de Tours
Claude Jacquot - Hôpital Albert Michallon
Christian Julien - Centre Hospitalier de Versailles
Laurent Laborie - Centre Hospitalier Universitaire de Besançon
Claude Lambert - Centre Hospitalier Universitaire de Saint-Étienne
Pascal Larroche - Hôpital Maison Blanche
Xavier Leclerc - Hôpital Roger Salengro
Laurent Lemaître - Hôpital Claude Huriez
Francisque Leynadier - Hôpital Tenon
Agnès Lillo-Le-Louet - Hôpital Européen Georges-Pompidou
Jean-Pierre Louvel - Centre Hospitalier Universitaire de Rouen
Nathalie Louvier - Centre Georges François Leclerc
Marie-Madeleine Lucas - Hôpital Pontchaillou
Geneviève Meites - Hôpital Rangueil
Nicolas Mennesson - Hôpital Edouard Herriot
Liliane Metge - Centre Hospitalier Universitaire de Nîmes
Yannick Meunier - Hôpital Charles-Nicolle
Laurence Monnier-Cholley - Hôpital Saint-Antoine
Mariano Musacchio - Hôpital Pasteur
Brigitte Nicolie - Centre Hospitalier Universitaire d'Angers
Gisèle Occelli - Hôpital Pasteur
Hélène Oesterle - Hôpital Pasteur
Francine Paisant-Thouveny - Centre Hospitalier Universitaire d'Angers
Michel Panuel - Hôpital Nord
Nadine Railhac - Hôpital Purpan
Frédérique Rety-Jacob - Hôpital Lyon Sud
Cécile Rochefort-Morel - Hôpital Pontchaillou
Catherine Roy - Hôpital Civil, Strasbourg
Philippe Sarlieve - Centre Hospitalier Universitaire de Besançon
Musa Sesay - Hôpital Pellegrin
Catherine Sgro - Hôpital Ambroise-Paré
Patrice Taourel - Hôpital Lapeyronie
Patrick Terrier - Hôpital Charles-Nicolle
Odile Theissen - Hôpital Pasteur
Ingrid Topenot - Hôpital Edouard Herriot
Jocelyne Valfrey - Centre Hospitalier Universitaire [Strasbourg]
Francis Veillon - Hôpital d'Hautepierre
Marie-Claude Vergnaud - Centre Hospitalier Universitaire de Caen
Charles Veyret - Hôpital Nord
Denis Vincent - Centre Hospitalier Universitaire de Nîmes
Benoit Wallaert - Hôpital Albert Calmette
François Wessel - Service de pneumologie [Nantes]
Marc Zins - Hôpital Saint Joseph
Publication Details: EClinicalMedicine, Vol.1, pp.51-61
Identifiers: 9940435709311
Academic Unit: Institut des Neurosciences de Montpellier - INM
Language: English
Resource Type: Journal article
Local Fields: hal-02304698