MAIN TEXT
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.