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

Olivier Clément 1, 2 Pascale Dewachter Claudie Mouton-Faivre 3 Camille Nevoret 4 Laurence Guilloux 5 Evelyne Bloch Morot 6 Sandrine Katsahian 4 Dominique Laroche 7 Martine Audebert 8 Béatrice Benabes-Jezraoui 8 Yves Benoit 9 Sylvie Beot 3 Frédéric Bérard 10 Yves Berthezène 11 Philippe Bertrand 12 Juliette Bouffard 13 Jean-Luc Bourrain 14 Bruno Boyer 15 Marie-France Carette 16 Christine Caron-Poitreau 17 Béatrice Cavestri 18 Jean Pierre Cercueil 19 Denis-André Charpin 20 Evelyne Collet 21 Arielle Crombe-Ternamian 9 Jacques Dalmas 22 Eric Decoux 23 Marie-France Defrance 24 Yvonne Delaval 25 Pascal Demoly 23, 26 Claude Depriester Pascale Depriester 8 Alain Didier 27 Martine Drouet 17 Benoît Dupas 28 Dominique Dupre-Goetchebeur 29 Charles Dzviga 30 Christine Fabre 31, 32 Gilbert Ferretti 33 Corinne Fourre-Jullian 22 Pascal Girardin 34 Jacques Giron 35 Marion Gouitaa 20 Nicolas Grenier 36 Lydie Guenard Bilbault 3 Stéphane Guez 36 Nathalie Gunera-Saad Jean-François Heautot 37 Dominique Herbin 38 Cyrille Hoarau 39 Claude Jacquot 40 Christian Julien 38 Laurent Laborie 41 Claude Lambert 42 Pascal Larroche 43 Xavier Leclerc 44 Laurent Lemaître 45 Francisque Leynadier 16 Agnès Lillo-Le-Louet 4 Jean-Pierre Louvel 46 Nathalie Louvier 47 Marie-Madeleine Lucas 25 Geneviève Meites 48 Nicolas Mennesson 9 Liliane Metge 31 Yannick Meunier 49 Laurence Monnier-Cholley 50 Mariano Musacchio 51 Brigitte Nicolie 17 Gisèle Occelli 52 Hélène Oesterle 51 Francine Paisant-Thouveny 17 Michel Panuel 20 Nadine Railhac 35 Frédérique Rety-Jacob 13 Cécile Rochefort-Morel 25 Catherine Roy 53 Philippe Sarlieve 41 Musa Sesay 36 Catherine Sgro 54 Patrice Taourel 23, 26 Patrick Terrier 55 Odile Theissen 51 Ingrid Topenot 9 Jocelyne Valfrey 53 Francis Veillon 56 Marie-Claude Vergnaud 57 Charles Veyret 30 Denis Vincent 31 Benoit Wallaert 58 François Wessel 59 Marc Zins 24
1 Service de Radiologie [CHU HEGP]
2 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
3 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
4 HEGP - Hôpital Européen Georges Pompidou [APHP]
5 Biomnis Laboratory
6 Service de Médecine Interne [CHU HEGP]
7 CHU Caen
8 CHU Amiens-Picardie
9 Hôpital Edouard Herriot [CHU - HCL]
10 Service d'immunologie [Centre Hospitalier Lyon Sud - HCL]
11 Hôpital de la Croix-Rousse [CHU - HCL]
12 CHRU TOURS - Centre Hospitalier Régional Universitaire de Tours
13 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
14 CHU Grenoble
15 ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin
16 Service de dermatologie et allergologie [CHU Tenon]
17 CHU Angers - Centre Hospitalier Universitaire d'Angers
18 Hôpital Albert Calmette
19 Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon)
20 Hôpital Nord [CHU - APHM]
21 Service de Dermatologie (CHU de Dijon)
22 CH Martigues
23 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
24 Groupe hospitalier Paris Saint-Joseph - Hôpital
25 CHU Pontchaillou [Rennes]
26 UM - Université de Montpellier
27 Service de pneumologie [Toulouse]
28 CHU Nantes - Centre hospitalier universitaire de Nantes
29 CHU - BREST - Hôpital Morvan - CHRU de Brest
30 Service de radiologie [Saint-Etienne]
31 CHRU Nîmes - Centre Hospitalier Régional Universitaire de Nîmes
32 INM - Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs
33 Service central de radiologie et d'imagerie médicale
34 CHRU Besançon - Centre Hospitalier Régional Universitaire [Besançon]
35 Hôpital Purpan [Toulouse]
36 Hôpital Pellegrin
37 Service de radiologie et imagerie médicale [Rennes]
38 CHPC - Centre Hospitalier Public du Cotentin [Cherbourg-Octeville]
39 Service de Néphrologie et d’Immunologie Clinique [CHRU Tours]
40 Clinique de réanimation médicale
41 Hôpital Jean Minjoz
42 CHU Saint-Etienne
43 DR - Brest - Département de radiologie [Brest]
44 Services de neuroradiologie [Lille]
45 Hôpital Claude Huriez
46 Service de Radiologie [Rouen]
47 CRLCC - CGFL - Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc
48 Hôpital de Rangueil
49 Service de réanimation médicale [Rouen]
50 Service de Radiologie [CHU Saint-Antoine]
51 Hôpital pasteur [Colmar]
52 CHU Nice - Centre Hospitalier Universitaire de Nice
53 CHU Strasbourg
54 Laboratoire de Pharmacologie-Toxicologie [CHU de Dijon]
55 Service de pneumologie, allergologie, mucoviscidose pédiatrique [Rouen]
56 Service de radiologie [Strasbourg]
57 Service de Médecine générale [CHU Caen]
58 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
59 Service de pneumologie [Nantes]
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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https://hal.umontpellier.fr/hal-02304698
Contributeur : Anthony Herrada <>
Soumis le : jeudi 3 octobre 2019 - 14:31:37
Dernière modification le : mercredi 4 décembre 2019 - 09:52:03

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UNIV-MONTPELLIER | HCL | CHLS | HEH | UNAM | UNIV-RENNES1 | UNIV-ST-ETIENNE | UNIV-PARIS5 | COMUE-NORMANDIE | UNIV-NANTES | UNIV-RENNES | SORBONNE-UNIVERSITE | UGA | USPC | CGFL | VAUTRIN | FNCLCC | BS | UNIV-COTEDAZUR | UNIROUEN | UNICAEN | UDL

Citation

Olivier Clément, Pascale Dewachter, Claudie Mouton-Faivre, Camille Nevoret, Laurence Guilloux, et al.. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study. EClinicalMedicine, Elsevier, 2018, 1, pp.51-61. ⟨10.1016/j.eclinm.2018.07.002⟩. ⟨hal-02304698⟩

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