Allergie immédiate aux produits de contraste iodés. P. Dewachter · C. Mouton-Faivre AFMU 2014

Diffusion le 03/11/2014

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L’hypersensibilité immédiate de nature allergique ou non allergique fait partie des effets indésirables rapportés avec les produits de contraste iodés (PCI). Leurs incidences et prévalences demeurent inconnues. Le diagnostic étiologique d’une réaction d’hypersensibilité immédiate après injection de PCI est fondé sur l’analyse de l’histoire clinique confrontée aux résultats de la biologie (histamine et tryptase) et à ceux des tests cutanés. La comparaison de ces éléments permet d’identifier le mécanisme physiopathologique de la réaction clinique (allergique vs non allergique), le PCI impliqué et de déterminer une conduite à tenir lors de procédures radiologiques ultérieures. La séquence épitopique des PCI n’a pas été identifiée mais ne correspond pas à l’atome d’iode. Il n’y a pas de communauté antigénique entre les produits de la mer, la povidone iodée et les PCI. Une allergie documentée aux produits de la mer ou à la povidone iodée ne contre-indique donc pas l’injection d’un PCI. L’atopie, l’asthme, les β-bloquants ne sont pas des facteurs de risque de survenue d’une allergie immédiate aux PCI. À l’inverse, un asthme non contrôlé par un traitement de fond majore le risque de décès au cours d’une anaphylaxie. Les arguments scientifiques en faveur de l’utilité d’une prémédication afin d’éviter une réaction allergique immédiate aux PCI font défaut. Une conduite à tenir est proposée lorsqu’un patient étiqueté « allergique à l’iode » ou ayant présenté une réaction immédiate avec un PCI explorée ou non, et adressé au service des urgences, doit bénéficier d’une procédure avec injection de PCI.

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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php