Table 2. Diagnosis and prevention of delayed HSRs to ICM presented in each clinical guideline.
| Clinical guideline | Diagnosis | Premedication | Change and selection of alternative contrast agent |
|---|---|---|---|
| American College of Radiology7 | • No specific mention of diagnostic test | • Premedication is not recommended for patients who have experienced mild delayed HSRs with skin symptoms. | • If culprit ICM is known in patients who have previously experienced delayed HSRs to ICM, a change of the ICM from the culprit to an alternative ICM is recommended. |
| • No specific mention of alternative ICM selection | |||
| European Society of Urogenital Radiology8 | • Patch and intradermal tests with delayed reading are recommended for patients who have previously experienced delayed HSRs to ICM. | • Premedication is generally not recommended. | • A change of the ICM from the culprit to a skin test-negative alternative ICM is recommended for patients who have previously experienced delayed HSRs to ICM. |
| European Academy of Allergy and Clinical Immunology (EAACI) position paper9 | • Skin test is recommended in all patients who have previously experienced delayed HSRs to ICM, except for emergent CT scan with ICM. | • Premedication is not recommended due to insufficient evidence. | • A change of the ICM from the culprit to a skin test-negative alternative ICM is recommended for patients who have previously experienced delayed HSRs to ICM. |
| • DPT can be used to identify proper alternative ICMs in patients with a negative skin test. | • Patients with the experience of ICM-induced severe cutaneous adverse reactions are recommended to avoid CT scans with ICM. | ||
| • DPT is recommended after considering the risks and benefits. | |||
| Spanish Society of Allergy and Clinical Immunology (SEAIC)10 | • Patch and intradermal tests with delayed reading are recommended for patients who have previously experienced delayed hypersensitivity. | • The preventive effect of pretreatment is controversial. | • A change of the ICM from the culprit to a skin test-negative alternative ICM is recommended for patients who have previously experienced delayed HSRs to ICM. |
| • DPT can be used to evaluate culprit ICM in case negative skin test. | |||
| • In severe cutaneous adverse reaction experienced patients, DPT with culprit ICM is contraindicated. |
HSR, hypersensitivity reaction; ICM, iodinated contrast media; DPT, drug provocation test.