NCT07409051

Persistence of Sensitization to Contrast Media

Evolution of IgE-mediated Sensitization to Contrast Media in Allergic Patients Diagnosed by Positive Skin Tests

• Status: Not Yet Recruiting
• Phase: —
• Study type: Observational
• Enrollment: 100 (estimated)
• Sponsor: University Hospital, Montpellier · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

The study aims to evaluate the persistence of IgE-mediated allergy to contrast media (CM) after a second exposure in patients who tested positive at both the first and second evaluations for CM allergy. It also aims to analyze the risk factors associated with the persistence of IgE-mediated sensitization after the second allergological assessment.

Detailed description

Drug allergy is often overdiagnosed, as only about 25% of cases labeled as allergic are confirmed. IgE-mediated drug allergy, responsible for immediate reactions up to anaphylaxis, carries inherent risks and relies primarily on in vivo testing, supplemented by in vitro assays in selected cases. In vivo assessment includes skin tests (ST), which, when positive, detect drug-specific IgE bound to mast cells, and drug provocation tests (DPT), which involve controlled re-exposure to the suspected drug. When IgE-mediated allergy is confirmed, drugs with positive ST are strictly contraindicated for life. Drugs with negative ST are generally considered safe, and tolerance is often verified through DPT performed in specialized settings using stepwise dose escalation up to near-therapeutic doses. In some cases, drugs are reintroduced directly in real-life conditions without prior DPT. Contrast media (CM) can trigger systemic reactions even at very low doses. In such cases, in vitro testing should ideally precede DPT to minimize systemic exposure. However, its use is limited by the small number of commercially available drug allergens, the need for specialized expertise for techniques such as the basophil activation test, and variable sensitivity depending on the drug, which remains largely unknown for CM. Skin testing for CM allergy has a very high negative predictive value (\>95%), indicating that most patients with negative ST tolerate subsequent CM exposure. As a result, many centers do not systematically perform DPT after negative ST. Evidence suggests that IgE-mediated drug allergy, including CM allergy, may decline over time, with conversion from positive to negative ST occurring after several years. However, it is unclear whether this reflects a true loss of clinical allergy, as documented re-exposures are rare and mostly anecdotal. Clinical experience shows that allergy may either resolve or persist despite negative follow-up tests. Finally, the severity of drug-induced allergic reactions may be increased in patients with mast cell activation syndrome or mastocytosis, conditions characterized by elevated mast cell burden or reactivity and often suspected in the presence of elevated baseline serum tryptase levels.

Conditions

• Contrast Media Allergy

Interventions

Type	Name	Description
DIAGNOSTIC_TEST	Skin testing	Commercial contrast media will be used to perform skin prick testing or intradermal testing with 0.02-0.05 mL of allergenic solution. If not previously performed, a standard panel of prick tests with environmental allergens will be used to assess atopic status. Positive (histamine 10 mg/mL) and negative (saline) controls will be included. Skin testing will begin with prick tests, starting at the dilution that was positive during the initial evaluation. If negative, testing will proceed with intradermal injections using increasing concentrations until a positive response is observed. Once a positive result is obtained, skin testing for that contrast medium will be discontinued. A prick test will be considered positive if a wheal ≥3 mm with erythema and pruritus appears after 15 minutes. An intradermal test will be considered positive if a wheal ≥3 mm with erythema and pruritus appears after 20 minutes.
OTHER	Baseline serum tryptase measurement	Seven milliliters of venous blood will be collected for baseline serum tryptase measurement.

Timeline

• Start date: 2026-02-01
• Primary completion: 2028-02-01
• Completion: 2028-02-01
• First posted: 2026-02-13
• Last updated: 2026-02-13

Locations

1 site across 1 country: France