Anaphylaxis following Intravenous Methylprednisolone Sodium Succinate in a Renal Transplant Recipient

Peces, R; Gorostidi, Manuel; Azofra, Julián; Sánchez, L.; Alvarez, J.

doi:10.1159/000186617

Cited by 23 publications

(10 citation statements)

References 13 publications

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“…Especially succinate esters seem to have a sensitizing potential [13]. Because of their low molecular weight, corticosteroids probably act as haptens [24,25,26]. …”

Section: Discussionmentioning

confidence: 99%

“…In recent years, immediate-type hypersensitivity reactions to succinylated corticosteroids have been described quite frequently [3,4,6,7,9,11,12,14,15,16,18,24,25,26,34,35,36,37,38,39,40,41] whereas such reactions to succinate-free corticosteroids seem to be less frequent [2,5,10,19,20,42,43,44]. A number of patients had positive skin prick tests to the eliciting and related corticoidsteroids [11,26,45,46].…”

Section: Discussionmentioning

confidence: 99%

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Immediate-Type Hypersensitivity to Succinylated Corticosteroids

Walker

Räwer

Sieber³

et al. 2010

Int Arch Allergy Immunol

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Background: Despite their frequent use, systemic corticosteroids have rarely elicited immediate-type reactions. Objective: We report two male patients, aged 26 and 70 years, respectively, with severe immediate-type hypersensitivity secondary to the administration of corticosteroids esterified with succinate. Methods: Skin tests, basophil activation tests and challenge tests were performed for diagnostic evaluation. Results: In both patients, immediate-type skin test reactions were found to methylprednisolone sodium hemisuccinate (MSH) and prednisolone sodium hemisuccinate (PSH). In contrast, nonsuccinylated corticosteroids (including methylprednisolone and prednisolone in one patient) yielded no test reactions. Basophils from one patient exhibited a stimulated expression of the activation marker CD63 upon in vitro incubation with PSH or hydrocortisone sodium succinate, but not with hydrocortisone. Skin tests and basophil activation tests were negative in controls. One patient was challenged with the incriminated drugs. He developed flush, conjunctivitis, tachycardia and dyspnea 2 min after injection of MSH, and dyspnea shortly after intravenous administration of PSH. Oral and intravenous challenge tests with nonsuccinylated corticosteroids were tolerated well by both patients. Conclusions: These case reports should alert clinicians to rare, but severe immediate-type reactions to corticosteroids, related to the succinate moiety in our patients. In case of allergic reactions to corticosteroids, it is mandatory to identify the causative agent and find safe alternatives.

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“…Especially succinate esters seem to have a sensitizing potential [13]. Because of their low molecular weight, corticosteroids probably act as haptens [24,25,26]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Immediate-Type Hypersensitivity to Succinylated Corticosteroids

Walker

Räwer

Sieber³

et al. 2010

Int Arch Allergy Immunol

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“…Skin tests and the reintroduction of other CSs without this particular ester or with another C21 substitution were all negative without exception. Others have confirmed the absence of cross-reactions between succinate CSs and agents carrying other esters (phosphate, for example), or with nonesterified hydrocortisone or methylprednisolone (66,67,89,(130)(131)(132). The opposite may also occur; e.g.…”

Section: Immediate Reactionsmentioning

confidence: 97%

Allergic hypersensitivity to topical and systemic corticosteroids: a review

Baeck

Marot

Nicolas

et al. 2009

Allergy

101

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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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“…The succinate ester used to enhance the solubility in parenteral preparations has been implicated in antigenicity in several immediate hypersensitivity case reports [13][14][15]. succinate, phosphate, butyrate and aceponate) which can increase skin penetration or solubility depending on the ester and position attached.…”

Section: Immediate Hypersensitivity To Corticosteroidsmentioning

confidence: 99%