The radiocontrast molecule in anaphylaxis: a surprising antigen.

X-ray contrast media are individually injected into human blood vessels in greater quantities than any other pharmacological substance. Adverse reactions to these substances have heretofore been considered anaphylactoid in nature. Others and we have demonstrated that the mechanisms involved are multifactorial and may involve activation of mast cells and basophils, activation of the complement system, activation of the contact system, and the conversion of L-arginine into nitric oxide. Appropriate pretreatment with corticosteriods will diminish the incidence of reactions. Most recently we have demonstrated that the contrast media function as 'pseudoantigens' (PsA). They can combine with antibodies, but cannot themselves produce antibodies. This property appears to be dependent on aggregation in high concentrations and varies with the individual media. It furthermore appears to be non-specific in relation to antibodies, and suggests that binding occurs to the Fc portion of immunoglobulins. We have now demonstrated that the least toxic of current media demonstrate the best antibody binding and in sufficient concentration can inhibit contrast induced mast cell activation and/or non-contrast antigen induced mast cell activation, apparently due to in vivo pseudoantigen excess. In lesser concentrations and/or lesser binding, the media can trigger mast cell activation.