Our results suggest the possibility of an IgE-mediated mechanism for allergic reactions to HC and MP, probably due, at least in part, to a steroid-glyoxal. We suggest that betamethasone and deflazacort could be reserved for emergency use in patients with adverse reactions to other corticosteroids.

Background-Over the last few years, changes in cutaneous homoeostasis resulting from sports activities have been reported. In particular, alterations in sweating mechanisms, the hydrolipid barrier, and surface bacterial flora, together with exposure to atmospheric conditions and the need to use medicaments, detergents, and other topical substances, predispose subjects to allergic contact dermatitis. Objective-To evaluate the incidence of allergic contact dermatitis in a group of young people practising sports activities. Methods-Patch tests were performed to confirm the diagnosis of irritant or allergic dermatitis; in addition, the radioallergoabsorbent test (RAST) to latex was evaluated in the group studied. Results-Allergic contact dermatitis caused by thiourams (23.3%) and mercaptobenzothiazole (20.9%) was prevalent. Other haptens, such as benzocaine and nickel, which are contained in clothing, equipment, topical medicaments, and creams used for massage, were also allergenic. In two cases, RAST positivity to latex was registered. Conclusions-The results suggest that close contact with sports equipment may increase the incidence of allergic contact dermatitis. Students practising certain sports may have "professional" allergic contact dermatitis to additives used in the production of rubber. (Br J Sports Med 2001;35:100-102) Keywords: skin; allergic contact dermatitis; latex; patch test; equipment; thiourams The increased exposure of human skin to the environment as the result of sports activities alters its barrier function against external agents. Firstly, the skin becomes the target of many stresses related to both physical exercise and the special clothing used in various sports, often more traditional than practical. In addition, physical exercise causes changes in the hydrolipid film and the skin pH, which tends to rise when its buVer systems, including lactic acid, glutamic acid and aspartic acid, undergo changes. Moreover, increased sweating associated with reduced opportunity for evaporation in sports attire such as the suits worn by fencers and the fire resistant overalls worn by racing drivers modifies the defensive capacity of the skin, altering the hydrolipid barrier and surface microbial flora. 1At the same time, exposure to sun and other atmospheric conditions triggers a series of reactions such as dissolution of molecular bonds, formation of oxygen free radicals, production of peroxidase, and denaturation of some protein structures.2 Finally, frequent washing and the use of medicaments and other topical substances alter the normal physiological skin balance in athletes, increasing the possibility for allergising substances to penetrate and therefore increasing the incidence of irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD). The onset of ICD, especially after contact with solvents or other aggressive organic substances, may be aggravated by hyperhydrosis. ACD is elicited after contact and re-exposure to the same sensitising agent, with contributions from variou...

Glucocorticoids (GCs) represent the most effective treatment for autoimmune and allergic diseases, even if collateral effects are not rare, especially endocrine and immunosuppressive manifestations. Moreover, these drugs can develop adverse immunological reactions of I, III or IV type. Though immediate adverse reactions caused by systemic therapy with GCs are not very frequent, the possible beginning of anaphylactic and pseudo-anaphylactic manifestations in patients undergoing therapy with these drugs has to be considered. It has been observed that immediate adverse reactions usually are happened in asthmatic patients and in patients obliged to assume GCs again and again because of their pathology (e.g, kidney transplant). Other risk factors resulted to be female sex and hypersensibility to acetylsalicylic acid (ASA). Both in the cases of pseudo-allergic and allergic reactions, the pharmacological principle is hardly the responsible agent for the reaction; instead the excipients in drugs are often implicated (succinate salt, sulphites and carboxy-methyl-cellulose). It is possible that the IgE-response is highly specific for a fixed GC molecule as well depending on the way of administration and its salification. Moreover, it has been hypothesized that in patients with a first type allergic reaction to GCs there is a fourth type, sensitization to GCs, which is not usually diagnosed and even comes before IgE sensitization. Third type hypersensibility reactions may occur, too. Since GCs are large-scale drugs, also in emergency medicine and reanimation, allergic sensitization towards them, although infrequent, gives many interventionist problems. In the light of this feature, it seems of crucial importance to verify the tolerance toward other GC molecules. And in particular, it has been noted that patients presenting immediate reactions to hydrocortisone (HC) and methylprednisolone (MP) could tolerate prednisone and prednisolone per os and second-generation GCs, such as desamathazone and betamethazone. Nevertheless, second-generation GCs must not be considered safe; in fact, the beginning of allergic manifestations has been pointed out even towards them.

An increasingly intensive training programme is not associated with greater risk of allergic disease in soccer players. Therapy regimens of allergic athletes and exercisers should be monitored more closely to guarantee adequate treatment yet avoid inappropriate drug use and doping practices.

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