A Case of Sensitization to Oral Corticosteroids

Abstract

A 29 year‐old woman who developed generalized erythematous eruptions after oral treatment with predonisolone tablets for facial dermatitis is described. Patch tests showed a positive reaction to both predonisolone tablets diluted in cream and a commercial predonisolone ointment. After oral challenges with 5mg predonisolone in tablet form and 4mg predonisolone powder, similar eruptions reappeared the next day. In both patch and dose testing with many kinds of corticosteroids, the patient showed a cross‐sensitivity to methyl‐predonisolone and its acetate only.

Allergic cutaneous reactions to systemic corticosteroids

“…The most common reactions to orally administered corticosteroids occurred with prednisolone ( Table 1). [6][7][8][9][10][11] Allergic reactions were also noted with prednisone, betamethasone, and triamcinolone, though in lesser numbers. [12][13][14][15][16] The majority of these cutaneous reactions were widespread in their presentations, including generalized dermatitis and urticarial reactions.…”

Delayed systemic allergic reactions to corticosteroids

“…Although allergic contact dermatitis from topical corticosteroids is reportedly becoming more common ( 1-7), systemically administered corticosteroids still appear to be an infrequent cause of both immediate (2,(8)(9)(10)(11)) and delayed (1, 2,8,12,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] reactions. The infrequent delayed systemic reactions have been described as dermatitic and exanthematous eruptions.…”

“…Testing with systemic rechallenge, intradermal injection, and patch testing is variably positive. It is notable that in reports in which patch testing has been done, positive patch tests have been demonstrated in cases where the preceding rashes have been described as "dermatitic" (18,22), "intensely pruritic" and "erythematous" (13,22,23,27), "papulovesicular" (20), "erythrodermic" (21 ), "maculopapular" (25,29), and "pustular" (28); in cases in which patch testing has been negative, but intradermal testing has been positive at 24 h (14, 15) and 48 and 72 h (14), the preceding rashes have been described as "maculopapular" (15) or "urticaria" (14) appearing.…”

“…As may be seen from Table 1, investigators have interpreted the generalized reactions from systemic corticosteroids as "delayed hypersensitivity reaction" (13,14), "hypersensitivity reaction" (15), "Type III immune reaction" (16), "allergic reaction" (17,22), "systemic (allergic) contact dermatitis" (18,21,25), "sensitization" (20,27), "drug (steroid) allergy" (23,24,28,29) and "generalized purpura reaction" (26). NO generalized purpuric reaction to hydrocorti-sone (note: excipient al-lergy cannot be ex-eluded) Positive to: generalized sensitiza-prednisolone 0.5% tion reaction to pred-ointment nisolone (oral rechal-methylprednisolone lenge with pure pred-0.25% cream nisolone powder Negative to: reproduced the reac-hydrocortisone hydro-tion) cortisone acetate dexa-methasone six other CCS Positive at 24,48, and pustular exanthem due 72 h to: to prednisolone prednisolone 0.25% prednisolone succinate 0.5% Negative to: flumethasone pivalate 0.02% dexamethasone 0.05% fluocinolone acetonide 0.025% Positive to: allergy to stereoiso-betamethasone meric steroids dexa-dexamethasone methasone and betame-desoximetasone thasone halcinonide several excipients CCS: corticosteroids; NS: not stated; NO: not done.…”