Palabras clave
Anafilaxia
Prevalencia
Factores de riesgo
Poblaciones vulnerables
Osmolaridad
Prueba in vitro
Pacientes pediátricos
Mujeres embarazadas
Hipersensibilidad
Premedicación
Cómo citar
Resumen
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.
PALABRAS CLAVE: Medios de contraste yodados; Anafilaxia; Prevalencia; Factores de riesgo; Poblaciones vulnerables; Osmolaridad; IgE; Células T; Prueba in vitro; Pacientes pediátricos; Mujeres embarazadas; Hipersensibilidad; Premedicación.
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