Stratified prevention strategies for iodine-based contrast media hypersensitivity: A meta-analysis of skin test utility and cross-reactivity

BackgroundPatients 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.PurposeTo 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 MethodsMEDLINE/EMBASE were systematically searched for studies on skin testing in ICM-allergic patients. Data were pooled via a random-effects model.ResultsA 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.ConclusionLow 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.