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Journal article
The role of skin testing, drug challenge and IFN-γ ELISpot in delayed hypersensitivity to iodinated contrast media
Allergy, asthma, and clinical immunology, Vol.21(1), 35
2025
PMID: 40813693
Abstract
Background
The use of in vivo and ex vivo diagnostic tools for delayed hypersensitivity reactions (DHRs) associated with iodinated contrast media (ICM) is currently ill-defined.
Objective
To evaluate the role of in vivo and ex vivo diagnostic tools for DHRs occurring >6 h following intravenous low-osmolality ICM.
Methods
We conducted a prospective, multicenter, international cohort study. The patients were recruited from two tertiary care adult allergy clinics, Austin Health, Australia and the McGill University Health Centre, Canada. Eligible participants were adults who reported a DHR after receiving ICM. In vivo testing (skin testing and intravenous challenge) was performed to identify an alternative agent. Ex vivo testing using interferon-γ enzyme-linked ImmunoSpot assay was performed in four Australian patients to explore its diagnostic performance.
Results
The culprit ICM was identified by dIDT in 17/20 (85%) while in 3/20 (15%) a challenge was necessary to confirm delayed hypersensitivity. All patients with a positive dIDT to iohexol were positive to iodixanol (15/15; 100%) while 3/4 (75%), 3/4 (75%), 4/6 (67%), and 3/5 (60%) were positive to iopromide, ioversol, iopamidol, and iobitridol, respectively. Overall, 7/20 (35%) patients tolerated a challenge with an alternative ICM. The IFN-γ release assay was negative for the implicated ICM in 4 patients with confirmed DHR through a positive dIDT.
Conclusion
dIDT allowed confirmation of T cell-mediated allergy to the implicated ICM in 85% of patients with a strong clinical suspicion of DHR and identification of non-cross-reactive ICM in 35% of patients. The IFN-y ELISpot was not useful in the four patients tested.
Details
- Title
- The role of skin testing, drug challenge and IFN-γ ELISpot in delayed hypersensitivity to iodinated contrast media
- Authors/Creators
- Ana Maria Copaescu - Austin HospitalKyra Y L Chua - Austin HealthEffie Mouhtouris - Austin HealthNatasha E Holmes - Austin HealthMoneerah AlGassim - McGill University Health CentreIbtihal Al Otaibi - McGill University Health CentreFlorian Stehlin - University Hospital of LausanneGhislaine A C Isabwe - McGill University Health CentreChristos Tsoukas - McGill University Health CentreJean-Francois Toupin - McGill University Health CentreDerek Lee - Montreal General HospitalMoshe Ben-Shoshan - McGill University Health CentreElizabeth J Phillips - Center for Drug Safety and Immunology, Department of Medicine, Dermatology, Pathology, Microbiology & Immunology, Vanderbilt University Medical Centre, Nashville, TN, USAJason A Trubiano - Austin Health
- Publication Details
- Allergy, asthma, and clinical immunology, Vol.21(1), 35
- Publisher
- BioMed Central Ltd unless otherwise stated. Part of Springer Nature.
- Number of pages
- 13
- Identifiers
- 991005807948007891
- Copyright
- © The Author(s) 2025.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.265 Dermatology - Skin Allergies
- 1.265.2004 Iopamidol
- Web Of Science research areas
- Allergy
- Immunology
- ESI research areas
- Immunology