Table 2.

A non-exhaustive overview of the positive aspects and limitations associated with the use of DPTs in diagnosing hypersensitivity to CM

Pros	Cons
Diagnostic confirmation: DPTs can serve as a definitive step in diagnosing hypersensitivity reactions to CM. They can confirm or rule out an allergy when skin tests are inconclusive or negative.10	Risks of DPT: DPTs carry a risk for inducing severe hypersensitivity reactions46 and other side effects (eg, renal complaints including CI-AKI) not to be neglected, as mentioned above.
Risk assessment: DPTs may offer a clearer assessment of the risk for future CM administration, which is crucial for patients requiring recurrent imaging.	Breakthrough reactions despite negative DPT: Despite the screening, a significant number of breakthrough reactions still occur despite using DPT-negative CMs, indicating that the method cannot eliminate the risk of reactions,6,44 as mentioned above.
Identification of safe alternative: DPTs can help identify safe alternative CMs for patients with a history of reactions.8,10,36	False results: False positive or negative reactions.
	Potential for false security: Premedication protocols to prevent reactions are not foolproof and may give a false sense of security. Breakthrough reactions can still occur.46
	Potential for spontaneous desensitization: There is a possibility that a negative result might be due to a spontaneous desensitization rather than true tolerance.47
	No standardized protocols: No standardized procedure exists. Comparing results from different publications and health institutions is difficult, as mentioned above.
	Resource intensive: DPTs are time-consuming and resource-intensive procedures requiring careful monitoring and emergency readiness, which may not be practical in every healthcare situation and institution.10,46
	Low sensitivity: SPT and IDT have a low sensitivity. Moreover, the time frame of the test is also important (within the first 6 months following the acute event).46