Soon Ho Yoon MD, Presenter: Nothing to Disclose

Suh-Young Lee, Abstract Co-Author: Nothing to Disclose

Hye-Ryun Kang, Abstract Co-Author: Nothing to Disclose

Seokyung Hahn PhD, Abstract Co-Author: Nothing to Disclose

Chang Min Park MD, PhD, Abstract Co-Author: Nothing to Disclose

Jin Mo Goo MD, PhD, Abstract Co-Author: Research Grant, Guerbet SA

Yoon-Seok Chang, Abstract Co-Author: Nothing to Disclose

Sang-Heon Cho, Abstract Co-Author: Nothing to Disclose

To systematically review and meta-analyze the role of skin tests in patients with HSR to ICM in terms of positive rate, cross-reactivity rate, and tolerability to skin test-negative ICM according to the type of HSR (immediate or non-immediate).

Two authors independently performed a literature search of the MEDLINE and EMBASE databases to identify relevant publications. We included studies in which skin tests were performed in patients who experienced HSR to ICM, with extractable outcomes. Two reviewers extracted data on the study characteristics, skin test, ICM, and outcomes. Disagreements were resolved through consensus. Outcomes were pooled using a random-effects model.

Twenty-one studies were included. Pooled per-patient positive rates of skin tests were 17% (95% CI, 10-26%; I2, 46%) in patients with immediate HSR, and up to 52% (95% CI, 31-72%; I2, 42%) when confined to severe immediate HSR. Among patients with non-immediate HSR, the positive rate was 26% (95% CI, 15-41%; I2, 45%). The pooled per-patient cross-reactivity rate was higher in non-immediate HSR (68%; 95% CI, 48-83%; I2, 36%) than in immediate HSR (39%; 95% CI, 29-50%; I2, 9%). Median per-test cross-reactivity rates between pairs of ICMs were 7% (IQR, 6-9%) in immediate HSR and 38% (IQR, 22-51%) in non-immediate HSR. Pooled per-patient recurrence rates of HSR to skin test-negative ICM were 7% (95% CI, 4-14%; I2, 0%) in immediate HSR, and 35% (95% CI, 19-55%; I2, 31%) in non-immediate HSR. There were heterogeneities across studies in the severity of HSR, use of culprit ICM, number of tested ICMs for a skin test, and the time interval between HSR and the skin test affecting the positive rate of skin tests. 

Skin tests proved the causative agent in a portion of patients with HSR to ICM and identified cross-reactive ICMs. More frequent and non-specific cross-reactivities were found in patients with non-immediate HSR. Skin tests may help determine non cross-reactive, alternative ICM in patients with immediate HSR to ICM. 

Skin test may be helpful in diagnosing and managing patients with a previous history of HSR to ICM, especially in patients with a history of severe immediate HSR demanding subsequent use of ICM. 

Yoon, S, Lee, S, Kang, H, Hahn, S, Park, C, Goo, J, Chang, Y, Cho, S, Skin Tests in Patients with Hypersensitivity Reaction to Iodinated Contrast Media: A Meta-analysis .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045493.html