{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:14:43Z","timestamp":1791328483933,"version":"4.3.1"},"reference-count":10,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/N025989\/1\/RCUK"],"award-info":[{"award-number":["MR\/N025989\/1\/RCUK"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000836","name":"University of Liverpool","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000836","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Bristol-Myers-Squibb"},{"name":"Medical Research Council"},{"DOI":"10.13039\/100004336","name":"Novartis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004336","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UCB Pharma"},{"name":"BMS"},{"name":"MSD"},{"name":"MRC"},{"name":"Otsuka Pharmaceuticals"},{"name":"Eli Lilly and Company Limited"},{"name":"Roche Pharma"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2021,5,6]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then developed a Stevens-Johnson syndrome reaction after coadministration of atezolizumab. Causality was confirmed by a positive re-challenge with amidotrizoate and laboratory investigations that implicated T cells. Importantly, the introduction of atezolizumab appears to have altered the immunologic response to amidotrizoate in terms of the tolerance\u2013elicitation continuum. Proof of concept studies demonstrated enhancement of recall responses to a surrogate antigen panel following <jats:italic>in-vitro<\/jats:italic> (healthy donors) and <jats:italic>in-vivo<\/jats:italic> (ICI patients) administrations of ICIs. Our findings highlight the importance of considering all concomitant medications in patients on ICIs who develop immune-mediated adverse reactions. In the event of some immune-related adverse reactions, it may be critical to identify the culprit antigen-forming entity that the ICIs have altered the perception of rather than simply attribute causality to the ICI itself in order to optimize both patient safety and treatment of malignancies.<\/jats:p>","DOI":"10.1136\/jitc-2021-002521","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T13:04:34Z","timestamp":1622207074000},"page":"e002521","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab"],"prefix":"10.1136","volume":"9","author":[{"given":"Sean","family":"Hammond","sequence":"first","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"},{"name":"ApconiX, Alderley Park, Alderley Edge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Olsson-Brown","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serat-E","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Jolly","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Ressel","sequence":"additional","affiliation":[{"name":"Department of Veterinary Pathology and Public Health, Leahurst Campus, Neston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munir","family":"Pirmohamed","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Naisbitt","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"key":"2025100315141999000_9.5.e002521.1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27549"},{"key":"2025100315141999000_9.5.e002521.2","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1302720"},{"key":"2025100315141999000_9.5.e002521.3","doi-asserted-by":"crossref","unstructured":"Kimura H , Hasegawa A , Takei I , et al . Characteristic pathological features of keratinocyte death in a case of Stevens\u2013Johnson syndrome manifested by an immune checkpoint inhibitor. 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