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Steroid dependency despite omalizumab treatment of ABPA in cystic fibrosis

macrocyclic structure as postulated by the authors; nevertheless this hypothesis must not be rejected and should always be checked. Thus, all mild to severe adverse hypersensitivity reactions should be accurately documented with most of the available gadolinium in order to determine cross reactivities. This is all the more important since challenge with another gadolinium agent giving negative skin tests could be performed safely, therefore allowing these patients further MRI explorations if necessary. This documentation should now be as rigorous as for hypersensitivity reactions associated with iodinated contrast media (4). Moreover these gadolinium reactions may be IgE-mediated more often than with iodinated contrast media because gadolinium would lead to lesser nonspecific histamine release caused by hyperosmolarity.