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de Groot AC. Systemic allergic dermatitis (systemic contact dermatitis) from pharmaceutical drugs: A review. Contact Dermatitis 2021; 86:145-164. [PMID: 34837391 DOI: 10.1111/cod.14016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
The literature on systemic allergic dermatitis (SAD; also known as systemic contact dermatitis) is reviewed. Both topical drugs (from absorption through mucosae or skin) and systemic drugs (oral, parenteral, rectal) may be responsible for the disorder. The topical route appears to be rare with 41 culprit topical drugs found to cause SAD in 95 patients. Most reactions are caused by budesonide (especially from inhalation), bufexamac, and dibucaine. SAD from systemic drugs is infrequent with 95 culprit drugs found to cause SAD in 240 patients. The drugs most frequently implicated are mitomycin C, methylprednisolone (salt, ester), and hydrocortisone (salt). The largest group of culprit drugs consisted of corticosteroids (19%), being responsible for >30% of the reactions, of which nearly 40% were not caused by therapeutic drugs, but by drug provocation tests. The most frequent manifestations of SAD from drugs are eczematous eruptions (scattered, widespread, generalized, worsening, reactivation), maculopapular eruptions, symmetrical drug-related intertriginous and flexural exanthema (SDRIFE [baboon syndrome]) and widespread erythema or erythroderma. Therapeutic systemic drugs hardly ever cause reactivation of previously positive patch tests and infrequently of previous allergic contact dermatitis. The pathophysiology of SAD has received very little attention. Explanations for the rarity of SAD are suggested.
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Concha-Del Rio LE, Uribe-Reina P, De-La-Torre A. Allergy against Steroids in Ocular Inflammation. Ocul Immunol Inflamm 2020; 29:1633-1638. [PMID: 32643993 DOI: 10.1080/09273948.2020.1766511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Allergy to steroids is an uncommon and harmful condition that leads to a decrease in treatment options and increase in morbidity due to the suboptimal disease control. It can manifest as an immediate response or a delay manifestation. Worsening of underlying condition and not treatment response can indicate corticosteroids hypersensitivity as well. Despite its low prevalence, all clinicians should be aware of this condition and know the treatment options. This narrative review attempts to update information about corticosteroid allergy and we present a case of a patient with the diagnosis of Vogt Koyanagi Harada Syndrome with a history of steroids allergy, as an example, to integrate this information to the ocular inflammation field.
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Affiliation(s)
- Luz Elena Concha-Del Rio
- Asociación Para Evitar La Ceguera En México, Hospital Luis Sánchez Bulnes, Ciudad De México, San Lucas, México
| | - Pilar Uribe-Reina
- Research Group in Neurosciences NeURos. Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia.,Research Department-Escuela Barraquer, Escuela Superior De Oftalmología Del Instituto Barraquer De América, Bogotá, Colombia
| | - Alejandra De-La-Torre
- Research Group in Neurosciences NeURos. Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
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Lee YI, Lee M, Lee S, Kim DY. A Permanent Hair Loss in a Patient with Hypersensitivity to Intralesional Triamcinolone Injection. Ann Dermatol 2019; 31:217-220. [PMID: 33911573 PMCID: PMC7992691 DOI: 10.5021/ad.2019.31.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 11/08/2022] Open
Abstract
Despite multiple possible side effects, mesotherapy with a diverse mixture of unapproved products has been performed for the treatment of hair loss. In this case report, we present a rare case of permanent hair loss due to an allergic reaction from a mesotherapy mixture including triamcinolone acetonide. The patient showed a positive intradermal allergic skin test result for triamcinolone and therefore was diagnosed with scarring alopecia due to delayed type IV hypersensitivity to corticosteroid. This case study suggests that dermatologists should always be fully aware that both IgE-mediated and non-IgE-mediated hypersensitivity reactions from the corticosteroids as well as their mesotherapy excipients are possible in an effort to prevent irreversible adverse event from the mesotherapy.
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Affiliation(s)
- Young In Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Minseok Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sewon Lee
- Yonsei Leeand Skin Clinic, Seoul, Korea
| | - Do Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Fieß A, Halstenberg S, Fellas A, Frisch I, Steinhorst UH. Anaphylactic reaction to intravenous corticosteroids in the treatment of ocular toxoplasmosis: a case report. J Med Case Rep 2014; 8:110. [PMID: 24694257 PMCID: PMC4230808 DOI: 10.1186/1752-1947-8-110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/17/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction This case report presents for the first time an acute systemic allergic reaction to corticosteroids in a patient with ocular toxoplasmosis after treatment with intravenous cortisone, and discusses alternative treatments. Case presentation We present the case of a 57-year-old Caucasian woman with an anaphylactic reaction after intravenous injection of prednisolone-21-hydrogensuccinate (Solu-Decortin® H) given for the treatment of toxoplasmosis-associated chorioretinitis. Immediately after the injection, she developed an acute erythema of the legs and abdomen, angioedema, hypotension (blood pressure 80/40mmHg), tachycardia (heart rate 140/minute), hyperthermia (38.8°C), and respiratory distress. Allergological examinations showed a positive skin-prick test to prednisolone and methylprednisolone. In addition, an oral exposure test with dexamethasone (Fortecortin®) and betamethasone (Celestamine®) was conducted to find alternative corticosteroids for future treatments. After oral application, no local or systemic reactions were observed for these two substances. Conclusions This case report demonstrates that systemic allergic reactions are possible in patients with uveitis or other inflammatory ophthalmological conditions treated with intravenous corticosteroids. Intravenous administration of cortisone, for example, in the treatment of ocular toxoplasmosis, should always be conducted with caution because of a possible allergic reaction. For patients who react to a particular steroid, it is necessary to undergo allergological testing to confirm that the compound in question is indeed allergenic, and to identify other corticosteroids that are safe for future anti-inflammatory treatments.
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Affiliation(s)
- Achim Fieß
- Department of Ophthalmology, Dr, Horst-Schmidt-Clinics, Wiesbaden, Germany.
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Soria A, Baeck M, Goossens A, Marot L, Duveille V, Derouaux AS, Nicolas JF, Tennstedt D. Patch, prick or intradermal tests to detect delayed hypersensitivity to corticosteroids? Contact Dermatitis 2011; 64:313-24. [DOI: 10.1111/j.1600-0536.2011.01888.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baeck M, Marot L, Nicolas JF, Pilette C, Tennstedt D, Goossens A. Allergic hypersensitivity to topical and systemic corticosteroids: a review. Allergy 2009; 64:978-94. [PMID: 19416135 DOI: 10.1111/j.1398-9995.2009.02038.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Corticosteroids, which are potent anti-inflammatory and immunomodulator agents used in the treatment of various inflammatory diseases including allergic diseases, can in some cases produce immediate or delayed hypersensitivity reactions. This review summarizes the epidemiological and clinical characteristics of such reactions, including related diagnostic issues. It also presents a detailed analysis of the proposed immunological mechanisms including underlying cross-reactions.
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Affiliation(s)
- M Baeck
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
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Abstract
Contact allergic reactions to topical corticosteroids are common. Cutaneous hypersensitivity reactions to systemically administered corticosteroids might occur though less frequently. The purpose of this literature review is to examine reported cases of cutaneous reactions to systemically administered corticosteroids. The data are presented considering route of administration, type of drug, type of reaction, and testing results. Corticosteroid classifications, cross-reactions, and allergy testing methods are also discussed.
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Abstract
Corticosteroids are used to treat a variety of medical conditions. While topical preparations are known to commonly cause allergic contact dermatits, systemic use of these drugs rarely causes cutaneous reactions. (This paper presents) Two cases of (systemic) injectable corticosteroid use resulting in delayed hypersensitivity reactions are presented.
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Affiliation(s)
- Nilam Amin
- Department of Dermatology, Lutheran Medical Center, Brooklyn, NY, USA
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10
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Abstract
Despite widespread use for treatment of asthma and allergies, glucocorticoids may cause allergic reactions, even anaphylaxis. The incidence of adverse reactions to systemic glucocorticoids is 0.3%. The most commonly reported corticosteroids causing anaphylaxis like reactions are hydrocortisone, prednisone, and methylprednisolone. Most authors agree that allergic reactions to systemic corticosteroids are possibly immunoglobulin E mediated. We report a patient with asthma, aspirin allergy, and nasal polyps who developed bronchospasm following the administration of intravenous methylprednisolone sodium succinate during an acute asthmatic attack. We discuss the differential diagnosis of worsening asthma despite adequate treatment, and suggest corticosteroid-induced bronchospasm in our patient. Corticosteroid-induced bronchospasm should be considered when asthmatics fail to improve, or frankly deteriorate with systemic corticosteroid therapy, particularly when a history of aspirin allergy is present. TEACHING POINT: Know the differential diagnosis for worsening of asthma despite adequate treatment. Consider corticosteroid-induced bronchospasm when asthmatics fail to improve, or frankly deteriorate with systemic corticosteroid therapy. Corticosteroid-induced bronchospasm is more commonly seen in asthmatics with a history of aspirin allergy.
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Affiliation(s)
- Ankur Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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Berthelot JM, Tortellier L, Guillot P, Prost A, Caumon JP, Glemarec J, Maugars Y. Tachon's syndrome (suracute back and/or thoracic pain following local injections of corticosteroids). A report of 318 French cases. Joint Bone Spine 2005; 72:66-8. [PMID: 15681251 DOI: 10.1016/j.jbspin.2004.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2003] [Accepted: 01/14/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the frequency, features, and outcome of excruciating lumbar, dorsal, and/or thoracic pain following injections of local corticosteroids in rare instances. METHODS A questionnaire mailed to 500 French rheumatologists. RESULTS Three hundred and eighteen cases were reported by 92 rheumatologists (one event per 8000 injections or 6.5 years of practice), following injections into lumbar epidural space (39%), an upper limb (30%), a lower limb (mostly the heel) (24%), or other locations (7%), of cortivazol (67%), hydrocortisone (25%), betamethasone (7%), or paramethasone (1%). Symptoms occurred 1-5 min (78%) or less than 1 min (22%) after injection, and highly acute axial pain usually lasted for less than 5 min (34%) or 5-15 min (51%). In addition to pain in lumbar (84%) and/or dorsal regions (25%) [often preceded or associated with thoracic pain (36%)], other signs were: anxiety (87%), shortness of breath (64%), facial flushing (64%), diffuse sweating (41%), agitation (29%), transient cough (23%), abdominal pain (20%), transient hypertension (15%), paleness (10%), hypotension (8%), diarrhoea (3%) and headache (3%). None of these patients was known to be allergic, and urticaria developed in only 2%. Outcome was favourable in all cases (even though 4/318 patients were transiently hospitalised) with an overall duration of 25 +/- 71 min. Another injection was performed later in 146/318 cases (46%), but Tachon's syndrome recurred in only 20 of these 146 patients (14%). CONCLUSION The outcome of this impressive syndrome seems excellent. Tachon's syndrome might be the venous counterpart of Nicolau's syndrome (injection of corticosteroids in an artery).
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Affiliation(s)
- Jean-Marie Berthelot
- Rheumatology Unit, CHU Nantes University Hospital, 44093 Nantes cedex 1, France.
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Padial A, Posadas S, Alvarez J, Torres MJ, Alvarez JA, Mayorga C, Blanca M. Nonimmediate reactions to systemic corticosteroids suggest an immunological mechanism. Allergy 2005; 60:665-70. [PMID: 15813813 DOI: 10.1111/j.1398-9995.2005.00749.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Administration of corticosteroids (CS) by different routes may cause varying types of allergic reactions, thereby hampering their further use in affected patients. In order to verify an immunological involvement we evaluated a group of patients with symptoms compatible with nonimmediate allergic reactions to CS. METHODS Studies included patch and intradermal tests, immunohistochemical studies and controlled administration to reproduce the response. The cytokines interleukin (IL)-4, interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha were quantified in peripheral blood during the response. RESULTS Of 32 subjects evaluated presenting nonimmediate urticaria or exanthema, 21 were finally considered positive after re-exposure. The drugs most frequently involved were betamethasone and dexamethasone. Fewer than half the patients responded to prednisolone whilst some responded to three or more CS. Hydrocortisone and deflazacort were well tolerated by all the patients. Subjects with a positive intradermal or patch test had a perivascular mononuclear cell infiltrate with the presence of CD4 and CD8 lymphocytes positive for CD45RO+ (memory) and CD69 (activation marker) cells. Monitoring peripheral blood during the acute response showed expression of IFN-gamma and TNF-alpha, with downregulation of IL-4. CONCLUSION Adverse systemic responses to different CS are suggestive of a nonimmediate reaction. The symptoms elicited together with the immunlogical studies suggest a T-cell mediated response. The response to closely related CS was especially marked between betamethasone and dexamethasone, whereas hydrocortisone and deflazacort were well tolerated.
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Affiliation(s)
- A Padial
- Servicio de Alergologia, Hospital Universitario La Paz, Madrid, Spain
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Miguélez A, Mestre F, Martín A, Escalas J, Del Pozo LJ. Allergic reaction to intralesional Celestone Cronodose. Br J Dermatol 2003; 149:894-6. [PMID: 14616393 DOI: 10.1046/j.1365-2133.2003.05569.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pollock B, Wilkinson SM, MacDonald Hull SP. Chronic urticaria associated with intra-articular methylprednisolone. Br J Dermatol 2001; 144:1228-30. [PMID: 11422047 DOI: 10.1046/j.1365-2133.2001.04238.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reports of allergic reactions following treatment with systemic corticosteroids are rare, despite their widespread use. A 47-year-old man developed widespread urticaria, resistant to antihistamines, coinciding with injections of local anaesthetic and methylprednisolone for cervical spondylosis. He underwent immediate and delayed hypersensitivity tests. Intradermal tests showed immediate-type sensitivity to methylprednisolone and hydrocortisone. Patch tests were positive to 21 of 26 corticosteroids tested. A diagnosis of both an immediate and a delayed-type hypersensitivity to corticosteroids was made. With avoidance of all corticosteroids he has been free from urticarial rash for 9 months and has been able to stop all medication.
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Affiliation(s)
- B Pollock
- Department of Dermatology, Leeds General Infirmary, Leeds LS1 3EX, UK
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15
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Harris A, McFadden JP. Dermatitis following systemic prednisolone: patch testing with prednisolone eye drops. Australas J Dermatol 2000; 41:124-5. [PMID: 10812710 DOI: 10.1046/j.1440-0960.2000.00410.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although positive reactions to topical corticosteroids can occur in over 1% of a patch-test population, systemic reactions to oral corticosteroids are uncommon. A 45-year-old woman who gave a clear history of the generalization of a cutaneous eruption following oral prednisolone was positive on patch testing using prednisolone eye drops.
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Affiliation(s)
- A Harris
- St John's Institute of Dermatology, London, United Kingdom
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16
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Lew DB, Higgins GC, Skinner RB, Snider MD, Myers LK. Adverse reaction to prednisone in a patient with systemic lupus erythematosus. Pediatr Dermatol 1999; 16:146-50. [PMID: 10337682 DOI: 10.1046/j.1525-1470.1999.00037.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Oral corticosteroids are the main therapeutic choice for systemic lupus erythematosus (SLE). Adverse reactions to systemic corticosteroids rarely occur and the etiology is unclear in most cases. A 14-year-old girl with newly diagnosed SLE developed a pruritic bullous eruption while on prednisone. The patient had been treated successfully in the hospital with intravenous methylprednisolone. In preparation for discharge, the steroid preparation was changed to prednisone to which the patient reacted with a development of new crops of bullous lesions. Skin biopsy specimens of lesional areas showed a bullous eruption consistent with erythema multiforme. The patient underwent immediate and delayed hypersensitivity tests. Intradermal and patch tests to liquid prednisone were positive. The patient was discharged on oral methylprednisolone and has not had recurrence of the skin lesions. In conclusion, a case of prednisone sensitivity in a patient with SLE is presented here. An alternative preparation, methylprednisolone, was used to successfully treat her underlying condition.
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Affiliation(s)
- D B Lew
- Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, USA.
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Miranda-Romero A, Bajo-del Pozo C, Sánchez-Sambucety P, Martinez-Fernandez M, Garcia-Muñoz M. Delayed local allergic reaction to intralesional paramethasone acetate. Contact Dermatitis 1998; 39:31-2. [PMID: 9686977 DOI: 10.1111/j.1600-0536.1998.tb05810.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Miranda-Romero
- Servicio de Dermatologia, Hospital Universitario, Valladolid, Spain
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18
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Lyon CC, Beck MH. Allergic contact dermatitis reactions to corticosteroids in periorbital inflammation and conjunctivitis. Eye (Lond) 1998; 12 ( Pt 1):148-9. [PMID: 9614535 DOI: 10.1038/eye.1998.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Affiliation(s)
- R Polosa
- University Medicine, Southampton General Hospital, UK.
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20
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Figueredo E, Cuesta-Herranz JI, De Las Heras M, Lluch-Bernal M, Umpierrez A, Sastre J. Anaphylaxis to dexamethasone. Allergy 1997; 52:877. [PMID: 9284994 DOI: 10.1111/j.1398-9995.1997.tb02166.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E Figueredo
- Fundación Jimenez Díaz, Servicio de Alergia, Madrid, Spain
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Affiliation(s)
- N K Veien
- Dermatology Clinic, Aalborg, Denmark
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22
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Affiliation(s)
- J D Guin
- Department of Dermatology, University of Arkansas School of Medicine, Little Rock 72205, USA
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23
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Affiliation(s)
- M Isaksson
- Department of Occupational and Environmental Dermatology, Malmö University Hospital, Sweden
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24
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Moreno-Ancillo A, Martín-Muñoz F, Martín-Barroso JA, Díaz-Pena JM, Ojeda JA. Anaphylaxis to 6-alpha-methylprednisolone in an eight-year-old child. J Allergy Clin Immunol 1996; 97:1169-71. [PMID: 8626997 DOI: 10.1016/s0091-6749(96)70274-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Al-Arfaj AS. Allergy to prednisone. Ann Saudi Med 1996; 16:79-80. [PMID: 17372427 DOI: 10.5144/0256-4947.1996.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A S Al-Arfaj
- Department of Medicine, Rheumatology Division, King Khalid University Hospital, Riyadh, Saudi Arabia
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Gonzalo Garijo MA, Bobadilla González P. Cutaneous-mucosal allergic contact reaction due to topical corticosteroids. Allergy 1995; 50:833-6. [PMID: 8607567 DOI: 10.1111/j.1398-9995.1995.tb05058.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the case of a 41-year-old nonatopic women with a previous history of eczematous reaction due to hydrocortisone who suffered worsening of her perennial rhinitis in association with perinasal dermatitis from the use of budesonide in nasal spray form, and stomatitis and pharyngitis due to budesonide in a bronchial inhaler. Patch tests with a series of 25 corticosteroids, some of them at different concentrations and in different vehicles, were positive to tixocortol pivalate, hydrocortisone, budesonide, prednisolone, hydrocortisone butyrate propionate, triamcinolone acetonide, and fluocinolone acetonide. For some of them, a 1% solution in ethanol gave a positive reaction when a 20% mixture in petrolatum did not. Like other authors, we suggest that some multiple positives may represent sensitization to several steroids independently, true cross-reactions, or both, and that ethanol is a better vehicle than petrolatum.
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Affiliation(s)
- M A Gonzalo Garijo
- Allergology Department, Infanta Cristina University Hospital, Badajoz, Spain
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27
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Abstract
From the limited number of reports in the literature, it would appear that various types of delayed reactions from systemically, intralesionally, and intra-articularly administered corticosteroids are rare, particularly given their widespread use. The purpose of this literature review is to summarize in table form the reported cases of generalized delayed systemic corticosteroid reactions with respect to patient presentation, methods of evaluation, and conclusions reached. In total, 24 cases of generalized delayed systemic corticosteroid reactions have been reported in the literature. Clinical presentation (timing and cutaneous manifestations) as well as evaluation of these patients has been variable; reactions reported include eczematous or exanthematous eruptions, with or without bullae or purpura. In 16 cases, the diagnoses have been supported by positive patch or intradermal testing. Overall, it appears that generalized delayed systemic reactions to corticosteroids show considerable variability and are infrequently reported. Patch and intradermal tests with standardized allergens appear to be the most useful tests currently available to support this clinical diagnosis.
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Affiliation(s)
- S E Whitmore
- Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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