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

• Published in: Quantitative imaging in medicine and surgery Vol. 11; no. 9; pp. 4028 - 4041
• Main Authors: Schmid, Adrian A, Morelli, John N, Hungerbühler, Martin N, Boehm, Ingrid B
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 01-09-2021
• Subjects: Original; immediate reaction (IR); drug provocation test (DPT); risk stratification; non-immediate reaction (NIR); hypersensitivity reaction (HSR); Cross-reactivity; iodinated contrast medium (ICM); polyvalent reactions
• ISSN: 2223-4292; 2223-4306
• DOI: 10.21037/qims-20-1325

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