Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
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Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests

조영제에 의한 급성 전신성발진성농포증 환자에서 첩포시험으로 안전한 조영제 선별에 성공한 1예

  • Kim, Sun-Hyung (Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Seung-Youn (Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Choi, Young-Hee (Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Cheol-Hong (Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Hyun, In-Kyu (Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Choi, Jeong-Hee (Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine)
  • 김선형 (한림대학교 의과대학 동탄성심병원 호흡기알레르기내과) ;
  • 이승연 (한림대학교 의과대학 동탄성심병원 호흡기알레르기내과) ;
  • 최영희 (한림대학교 의과대학 동탄성심병원 병리과) ;
  • 김철홍 (한림대학교 의과대학 동탄성심병원 호흡기알레르기내과) ;
  • 현인규 (한림대학교 의과대학 동탄성심병원 호흡기알레르기내과) ;
  • 최정희 (한림대학교 의과대학 동탄성심병원 호흡기알레르기내과)
  • Received : 2017.09.07
  • Accepted : 2017.12.15
  • Published : 2018.09.30
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Abstract

Acute generalized exanthematous pustulosis (AGEP) is rarely caused by radiocontrast media (RCM). The role of skin tests for the diagnosis and evaluation of cross-reactivity in a delayed type of RCM-induced hypersensitivity have yet to be determined. Here, we report a case of iodixanol-induced AGEP where we safely administered alternative RCM using patch tests. A 44-year-old woman had coronary artery angiography (CAG) for the evaluation of ischemic heart disease. She was on regular hemodialysis because of endstage renal disease. She was given iodixanol (Visipaque) during CAG. Approximately 1 day after CAG, she developed AGEP. The patient was rehospitalized for CAG again after 1 year. We performed skin tests to choose safe alternative RCM. Intradermal tests with iodixanol, iohexol (Bonorex) and Iopamidol (Pamiray) showed negative responses. Patch tests showed a positive response to iodixanol, equivocal to iohexol, and negative to Iopamidol. We finally chose Iopamidol and performed CAG successfully without any adverse reaction. Patch tests may be a useful tool for the diagnosis and choice of safe alternatives in RCM-induced delayed-type hypersensitivity reactions such as AGEP.

Keywords

References

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