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INTRODUCTION
The use of contrast media (CM) enhances the quality of radiological studies, resulting in over 75 million examinations using iodinated contrast media (ICM) annually worldwide1. Although the incidence of hypersensitivity reactions (HSR) to ICM is less than 3%2,3, the high volume of ICM usage translates to more than 225,000 HSR per year4,5. Most reactions are mild; however, approximately 30,000 of these could be severe, with more than 70 reported fatalities6.
Therefore, this issue is highly relevant, yet only partial solutions have been proposed. In the event of an HSR to ICM, premedication with antihistamines and corticosteroids has been usually applied7-9, but present several limitations10-14, particularly because HSR can still occur despite its use with an incidence exceeding 10%15-18. Allergy testing has been advocated to evaluate the tolerance of ICM19-23. Given the low sensitivity of skin test (ST)19,24-29 and the significant and variable cross-reactivity (C-R) among different ICM21,30-32, it is advisable to perform a controlled drug provocation test (DPT) before administering an ICM that has shown a negative ST result 21,23,33,34.
DPT with ICM is not standardized, and various protocols have been proposed, typically involving the administration of increasing doses of ICM with observation intervals in between. This results in a total administration time ranging from a minimum of 2 hours for immediate HSRs to up to 2 days for delayed-type reactions22,30,33,35,36. This timeline differs significantly from the use of ICM in clinical practice, where it is administered within less than 1 minute during radiological examinations.