Grueber, Hans-Peter; Helbling, Arthur; Joerg, Lukas (2021). Skin Test Results and Cross-Reactivity Patterns in IgE- and T-Cell-Mediated Allergy to Gadolinium-Based Contrast Agents. Allergy, asthma & immunology research, 13(6), pp. 933-938. 10.4168/aair.2021.13.6.933
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Allergies to gadolinium-based contrast agents (GBCAs) are rare and manifest usually as an immediate drug hypersensitivity reaction (DHR), compatible with an immunoglobulin E (IgE)-mediated mechanism. Although the molecular structures of GBCA show some similarities and are either linear or macrocyclic, the frequency and pattern of cross-reactivity remain unclear. However, cross-reactivity has been described. The aim of this investigation was to assess cross-reactivity in patients with GBCA allergy based on skin tests and exposure. We retrospectively evaluated a total of 28 cases with a proven allergy to a GBCA, including 11 from the database of the allergy division of the Inselspital, Bern and 17 published cases from the literature, retrieved with a PubMed-MEDLINE search. The majority of cases were immediate DHR, with 8/11 cases from the database (72.7%) and 16/17 published cases (94.1%). In both groups macrocyclic GBCA were most often identified as causative drugs. A cross-reactivity based on skin test results was found in 2 out of 11 database cases (18.2%) and in 6 out of 17 literature cases (35.3%). Cross-reactivity occurred within macrocyclic GBCA in 1/11 database cases and 3/17 literature cases, and included both macrocyclic and linear GBCA in 1/11 and 4/17 subjects. There was no cross sensitization among linear GBCA. Skin test-negative GBCA were well tolerated, even in cases with sensitization to linear and macrocyclic GBCA. Overall, cross-reactivity in GBCA allergy is rare (approximately 29%), and may occur among macrocyclic GBCA or in between macrocyclic and linear GBCA. IgE to linear GBCA seems to be rarely cross-reactive. Skin test is helpful in identifying safe alternatives, as no reaction to skin test-negative GBCA was observed.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology |
UniBE Contributor: |
Helbling, Arthur, Jörg, Lukas |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2092-7355 |
Language: |
English |
Submitter: |
Heidi Lobsiger |
Date Deposited: |
21 Dec 2021 14:47 |
Last Modified: |
05 Dec 2022 15:57 |
Publisher DOI: |
10.4168/aair.2021.13.6.933 |
PubMed ID: |
34734510 |
Uncontrolled Keywords: |
Gadolinium-based contrast agent (GBCA) IgE T-cell allergy anaphylaxis contrast media cross-reaction drug hypersensitivity skin test |
BORIS DOI: |
10.48350/162535 |
URI: |
https://boris.unibe.ch/id/eprint/162535 |
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