Hipersensibilidad a medios de contraste yodado: estrategias diagnósticas y terapéuticas. Posicionamiento del Comité de Alergia a Medicamentos de Colegio Mexicano de Inmunología Clínica y Alergia.

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Title:	Hipersensibilidad a medios de contraste yodado: estrategias diagnósticas y terapéuticas. Posicionamiento del Comité de Alergia a Medicamentos de Colegio Mexicano de Inmunología Clínica y Alergia.
Alternate Title:	Hypersensitivity to iodinated contrast media: Diagnostic and therapeutic strategies. Position Statement of the Drug Allergy Committee of the Mexican College of Clinical Immunology and Allergy.
Authors:	Villarreal González, Rosalaura Virginia^1,2, Flores García, Nataly Anais², Astrid de la Fuente, Leslie¹ leslieastridd@gmail.com, Fraga Olvera, Alira³, Ávila Lara, Anabel⁴, Montiel Sierra, Ana Judith⁵, Robledo Martínez, Angelina Ingrid⁶, Correa Serrano, Carlos Alberto², García Rosas, Carolina⁷, Alonso Bello, César Daniel⁸, Rico Solís, Germán Agustín⁹, Ochoa García, Itzel Vianey¹⁰, Jimenez Sandoval, Jaime Omar¹¹, Ramírez Heredia, Jennifer¹², González Juárez, Kitzia¹³, Moreno González, Maciel Monserrat¹⁴, Ortega Cisneros, Margarita¹⁰, de la Luz Hortensia García Cruz, María¹⁵, Arias Martínez, María Isabel¹⁶, Hernández Ojeda, Mariana¹⁷
Source:	Revista Alergia de Mexico. ene-mar2026, Vol. 73 Issue 1, p76-92. 17p.
Subjects:	CONTRAST media, THERAPEUTICS, ALLERGIES, CROSS reactions (Immunology), DIAGNOSIS, DISEASE risk factors, IMMUNE system, PREMEDICATION
Abstract (English):	BACKGROUND: Hypersensitivity reactions to iodinated contrast media represent a relevant clinical issue due to their increasing use in radiodiagnostic procedures. These reactions are classified as immediate or non-immediate, immunological and non-immunological, with variable prevalence and potentially serious consequences such as anaphylaxis or severe cutaneous adverse reactions. Identifying risk factors, classification, and immunological mechanisms of iodinated contrast media enables the development of effective prevention and management strategies. OBJECTIVE: To analyze the chemical characteristics of iodinated contrast media, the associated immunological mechanisms, and available diagnostic tools to establish effective strategies for the prevention, diagnosis, and management of hypersensitivity reactions in both general and vulnerable populations. METHODOLOGY: A literature review was conducted analyzing the different types of contrast media according to their chemical structure, osmolarity, osmolality, and viscosity, highlighting their association with the risk of hypersensitivity reactions. The immunological mechanisms involved are described, including IgE-mediated responses, T-cell–mediated reactions, and activation of the MRGPRX2 receptor. Diagnostic tools such as in vivo, in vitro tests, and controlled exposure tests were examined in terms of sensitivity, specificity, and clinical utility. Cross-reactivity between iodinated contrast media agents and the usefulness of grouping them based on chemical characteristics to guide the selection of safer alternatives were addressed. Finally, therapeutic and preventive strategies were reviewed, including premedication protocols, iodinated contrast media selection, and special considerations for vulnerable populations such as pediatric patients, pregnant women, and older adults. CONCLUSIONS: Hypersensitivity to iodinated contrast media requires a multidisciplinary diagnostic and therapeutic approach based on accurate characterization of the reaction, immunological assessment, and personalized selection of contrast agents. Current knowledge allows for a significant reduction in HSR recurrence through substitution of the culprit agent and/or appropriate premedication, thereby improving the safety of contrast-enhanced diagnostic procedures. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	ANTECEDENTES: Las reacciones de hipersensibilidad a medios de contraste yodados representan un problema clínico relevante debido al uso creciente para estudios radiodiagnósticos. Estas reacciones se clasifican en inmunológicas inmediatas, no inmediatas y no inmunológicas, con una prevalencia variable y potenciales consecuencias graves (anafilaxia o reacciones adversas cutáneas graves). La identificación de factores de riesgo, clasificación y mecanismos inmunológicos de los medios de contraste permiten establecer estrategias de prevención y tratamiento. OBJETIVO: Analizar las características químicas de los medios de contraste, mecanismos inmunológicos y métodos diagnósticos disponibles, con la finalidad de establecer estrategias efectivas para su prevención, diagnóstico y tratamiento en poblaciones generales y vulnerables. MÉTODOLOGÍA: Se efectuó una revisión bibliográfica donde se analizaron los diferentes tipos de medios de contraste, según su estructura química, osmolaridad, osmolalidad y viscosidad, destacando su asociación con el riesgo de reacciones de hipersensibilidad. Se describen los mecanismos inmunológicos implicados, incluyendo respuestas mediadas por IgE, células T y el receptor MRGPRX2. Se detallan métodos diagnósticos: estudios in vivo e in vitro, y prueba de exposición controlada, evaluando la sensibilidad, especificidad y utilidad clínica. Se puntualiza la reactividad cruzada entre medios de contraste y la utilidad de agruparlos según sus características químicas para elegir alternativas seguras. Finalmente, se abordan estrategias terapéuticas y preventivas, como la premedicación, la selección del medio de contraste y las consideraciones especiales en poblaciones vulnerables (pacientes pediátricos, mujeres embarazadas y adultos mayores). CONCLUSIONES: La hipersensibilidad a medios de contraste requiere un enfoque diagnóstico y terapéutico multidisciplinario, basado en la adecuada caracterización de la reacción, estudios inmunológicos y selección personalizada del medio de contraste que de administrará. El conocimiento actual permite reducir significativamente la recurrencia de reacciones de hipersensibilidad mediante la sustitución del agente implicado y/o premedicación, optimizando así la seguridad de los procedimientos diagnósticos asociados con medios de contraste. [ABSTRACT FROM AUTHOR]
	Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database:	MedicLatina

Description
Abstract:	BACKGROUND: Hypersensitivity reactions to iodinated contrast media represent a relevant clinical issue due to their increasing use in radiodiagnostic procedures. These reactions are classified as immediate or non-immediate, immunological and non-immunological, with variable prevalence and potentially serious consequences such as anaphylaxis or severe cutaneous adverse reactions. Identifying risk factors, classification, and immunological mechanisms of iodinated contrast media enables the development of effective prevention and management strategies. OBJECTIVE: To analyze the chemical characteristics of iodinated contrast media, the associated immunological mechanisms, and available diagnostic tools to establish effective strategies for the prevention, diagnosis, and management of hypersensitivity reactions in both general and vulnerable populations. METHODOLOGY: A literature review was conducted analyzing the different types of contrast media according to their chemical structure, osmolarity, osmolality, and viscosity, highlighting their association with the risk of hypersensitivity reactions. The immunological mechanisms involved are described, including IgE-mediated responses, T-cell–mediated reactions, and activation of the MRGPRX2 receptor. Diagnostic tools such as in vivo, in vitro tests, and controlled exposure tests were examined in terms of sensitivity, specificity, and clinical utility. Cross-reactivity between iodinated contrast media agents and the usefulness of grouping them based on chemical characteristics to guide the selection of safer alternatives were addressed. Finally, therapeutic and preventive strategies were reviewed, including premedication protocols, iodinated contrast media selection, and special considerations for vulnerable populations such as pediatric patients, pregnant women, and older adults. CONCLUSIONS: Hypersensitivity to iodinated contrast media requires a multidisciplinary diagnostic and therapeutic approach based on accurate characterization of the reaction, immunological assessment, and personalized selection of contrast agents. Current knowledge allows for a significant reduction in HSR recurrence through substitution of the culprit agent and/or appropriate premedication, thereby improving the safety of contrast-enhanced diagnostic procedures. [ABSTRACT FROM AUTHOR]
ISSN:	00025151
DOI:	10.29262/ram.v73i1.1540