Patients with prior iodine-based contrast media (ICM) hypersensitivity reactions (HSR) face elevated recurrence risks, yet the clinical value of skin testing for risk stratification remains uncertain.
Purpose
To evaluate skin test efficacy, ICM cross-reactivity rates, and safety of test-negative agents, deriving patient-centered safety guidelines and clinician decision-support tools.
Material and Methods
MEDLINE/EMBASE were systematically searched for studies on skin testing in ICM-allergic patients. Data were pooled via a random-effects model.
Results
A total of 33 studies were included in the analysis. The overall positive rate for skin tests in patients with immediate HSR was 25% (95% confidence interval [CI] = 17–34), while in non-immediate HSR cases, it was 28% (95% CI = 22–35). Cross-reactivity was observed in 42% (95% CI = 31–54) of immediate HSR cases and 49% (95% CI = 34–64) of non-immediate HSR cases. Among non-immediate HSR patients, 20% (95% CI = 13–30) experienced recurrence of HSR to skin test-negative ICM.
Conclusion
Low skin test positivity and high cross-reactivity necessitate stratified prevention strategies. Non-immediate HSR patients tolerate test-negative ICM better, informing patient education priorities and clinician tools.
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