Abstract：
BACKGROUND: Two-dimensional (2D) classifications of iodinated contrast media (ICM) are insufficient to explain the observed skin test (ST) reactivity patterns in patients with drug hypersensitivity reactions (DHRs) to ICM.
OBJECTIVE: To refine the current view on allergic DHRs to ICM by analyzing ST reactivity patterns in patients with previous reactions to ICM.
METHODS: Patients with a history of DHR to ICM and positive STs, who presented at the University Hospital of Montpellier between 2004 and 2022, were included in the study. The relative difference between every two ICM products was measured by Manhattan distance and odds ratios were computed for all pairs of products in the immediate reaction (IR) and non-immediate reaction (NIR) ST groups.
RESULTS: A total of 181 patients were included in the study. Odds ratio analysis identified significant associations between classical cross-reactive ICM, such as iohexol-ioversol, iohexol-iomeprol, iomeprol-ioversol, and iohexol-iodixanol in the IR ST group and iohexol-ioversol, iopromide-iohexol, and iomeprol-ioversol in the NIR ST group. We also identified uncommon associations, such as ioxitalamate-amidotrizoate in the IR ST group and amidotrizoate-iopamidol and amidotrizoate-ioxitalamate in the NIR ST group. The results were reflected by the Manhattan distance, which suggested the existence of clusters containing the same classically associated ICM as well as uncommon associations, which we hypothesize to be related to similarities in the 3D structure of the respective ICM.
CONCLUSIONS: Current chemical (2D) classifications cannot explain all observed ST reactivity patterns. Whether the 3D structure can be integrated into the current classifications to interpret the observed ST reactivity patterns and predict tolerance to alternative ICM requires further research.
OBJECTIVE: To refine the current view on allergic DHRs to ICM by analyzing ST reactivity patterns in patients with previous reactions to ICM.
METHODS: Patients with a history of DHR to ICM and positive STs, who presented at the University Hospital of Montpellier between 2004 and 2022, were included in the study. The relative difference between every two ICM products was measured by Manhattan distance and odds ratios were computed for all pairs of products in the immediate reaction (IR) and non-immediate reaction (NIR) ST groups.
RESULTS: A total of 181 patients were included in the study. Odds ratio analysis identified significant associations between classical cross-reactive ICM, such as iohexol-ioversol, iohexol-iomeprol, iomeprol-ioversol, and iohexol-iodixanol in the IR ST group and iohexol-ioversol, iopromide-iohexol, and iomeprol-ioversol in the NIR ST group. We also identified uncommon associations, such as ioxitalamate-amidotrizoate in the IR ST group and amidotrizoate-iopamidol and amidotrizoate-ioxitalamate in the NIR ST group. The results were reflected by the Manhattan distance, which suggested the existence of clusters containing the same classically associated ICM as well as uncommon associations, which we hypothesize to be related to similarities in the 3D structure of the respective ICM.
CONCLUSIONS: Current chemical (2D) classifications cannot explain all observed ST reactivity patterns. Whether the 3D structure can be integrated into the current classifications to interpret the observed ST reactivity patterns and predict tolerance to alternative ICM requires further research.
摘要：
背景：碘化造影剂（ICM）的二维（2D）分类不足以解释在对ICM有药物超敏反应（DHRs）的患者中观察到的皮肤测试（ST）反应模式。
目的：通过分析先前对ICM有反应的患者的ST反应模式，完善对ICM过敏DHRs的当前观点。
方法：有ICM和STs阳性的DHR病史的患者，他在2004年至2022年间在蒙彼利埃大学医院就诊，被纳入研究。通过曼哈顿距离测量每两种ICM产物之间的相对差异，并计算即时反应（IR）和非即时反应（NIR）ST组中所有产物对的比值比。
结果：共181名患者纳入研究。赔率比分析确定了经典交叉反应性ICM之间的显著关联，如碘海醇-碘伏溶胶，碘海醇-iomeprol,iomeprol-ioversol,IRST组和碘海醇-碘克沙醇，碘普罗胺-碘海醇,NIRST组中的iomeprol-ioversol。我们还发现了不常见的关联，例如IRST组中的碘西他甲酸酯-氨基三环酸盐和NIRST组中的氨基三环酸盐-碘帕醇和氨基三环酸盐-碘西他甲酸酯。曼哈顿距离反映了结果，这表明存在包含相同经典关联的ICM以及不常见关联的集群，我们假设这与各自ICM的3D结构的相似性有关。
结论：当前的化学（2D）分类不能解释所有观察到的ST反应性模式。是否可以将3D结构整合到当前的分类中以解释观察到的ST反应性模式并预测对替代ICM的耐受性需要进一步的研究。
目的：通过分析先前对ICM有反应的患者的ST反应模式，完善对ICM过敏DHRs的当前观点。
方法：有ICM和STs阳性的DHR病史的患者，他在2004年至2022年间在蒙彼利埃大学医院就诊，被纳入研究。通过曼哈顿距离测量每两种ICM产物之间的相对差异，并计算即时反应（IR）和非即时反应（NIR）ST组中所有产物对的比值比。
结果：共181名患者纳入研究。赔率比分析确定了经典交叉反应性ICM之间的显著关联，如碘海醇-碘伏溶胶，碘海醇-iomeprol,iomeprol-ioversol,IRST组和碘海醇-碘克沙醇，碘普罗胺-碘海醇,NIRST组中的iomeprol-ioversol。我们还发现了不常见的关联，例如IRST组中的碘西他甲酸酯-氨基三环酸盐和NIRST组中的氨基三环酸盐-碘帕醇和氨基三环酸盐-碘西他甲酸酯。曼哈顿距离反映了结果，这表明存在包含相同经典关联的ICM以及不常见关联的集群，我们假设这与各自ICM的3D结构的相似性有关。
结论：当前的化学（2D）分类不能解释所有观察到的ST反应性模式。是否可以将3D结构整合到当前的分类中以解释观察到的ST反应性模式并预测对替代ICM的耐受性需要进一步的研究。
