Anaphylaxis-like reactions to corticosteroid therapy

Mendelson, Louis M.; Meltzer, Eli O.; Hamburger, Robert N.

doi:10.1016/0091-6749(74)90049-9

Cited by 111 publications

(46 citation statements)

References 6 publications

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“…It is interesting that there are a few reports on glucocorticoid allergic patients who tolerated only unconjugated nonesterified corticosteroids in challenge tests 6,17 ; by contrast, there is a single report of a patient who had positive skin testing only to glucocorticoids without succinate ester but tolerance of derivatives with succinate ester. 18 These findings suggest an independent immunologic potential of the esters. 6 Cross-reactivity has been observed between different systemic glucocorticoids, but the recent classification of cross-reactivity between topical glucocorticoids does not seem to apply for immediate adverse reactions to systemic glucocorticoids.…”

Section: Discussionmentioning

confidence: 65%

Anaphylaxis Induced by Glucocorticoids

Erdmann¹,

Abuzahra²,

Schroeder³

et al. 2005

The Journal of the American Board of Family Medicine

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Glucocorticoids are frequently used to treat allergic reactions. Therefore, allergic reactions to systemic glucocorticoids in particular are considered most unlikely and are not well known. We report on a 23-year-old woman with atopic dermatitis who had an anaphylactic reaction after oral administration of prednisolone. On treatment with epinephrine, antihistamines and volume symptoms resolved. Skin testing with a panel of glucocorticoids showed immediate type reactions to prednisolone, prednisolone hydrogen succinate, prednisone, and betamethasone dihydrogen phosphate. In challenge testing the patient tolerated methyl prednisolone and dexamethasone. There is increasing evidence that true allergic immediate type reactions to glucocorticoids exist. The severity of the reaction can vary from a rash to anaphylaxis. However, a patient sensitized to one or a group of glucocorticoids does not have to refrain from all types of glucocorticoids. Careful challenge testing is by far the best way to select glucocorticoids that are safe for future treatment. Clinicians should be aware that allergic reactions to glucocorticoids can occur and that worsening of symptoms does not always mean treatment failure. (J Am Board Fam Pract 2005;18:143-6.)Since the early 1950s, glucocorticoids have been used extensively for pharmacotherapy. Glucocorticoids are applied topically, orally, or intravenously and, if administered in higher doses, show immunosuppressive, antiproliferative, anti-inflammatory, and antiallergic effects.1 The antiallergic properties of glucocorticoids would seem to contradict their capacity to induce allergic reactions. However, a few severe adverse reactions, including life-threatening reactions caused by systemic glucocorticoids, have been reported over the past decades.2-6 Because the risk of anaphylactic reactions caused by glucocorticoids is not taken into consideration by most clinicians, severe complications may occur, particularly in the treatment of status asthmaticus or in anaphylactic reactions attributable to high doses (ie, if increasing symptoms are thought to be caused by insufficient therapy, even higher doses of glucocorticoids may be applied).We report a patient with an immediate and delayed type hypersensitivity to several glucocorticoids, the diagnostic work-up, including challenge testing, and the options for future treatment with glucocorticoids in patients with glucocorticoid allergy. Case ReportA 23-year-old woman was prescribed prednisolone (Decortin H) because of worsening of atopic dermatitis. Thirty minutes after taking the first oral dose of 40 mg of prednisolone, she developed palmoplantar paraesthesia, tightness of the chest, dizziness, and nausea, and she finally collapsed. In the emergency department, she was treated with epinephrine, antihistamines, and fluid; however, no glucocorticoid was applied because of the clinical history. Within a few hours all symptoms resolved. Two years before at the dentist's office, the patient had shown the same symptoms, albeit less severe, 15 minut...

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Section: Discussionmentioning

confidence: 65%

Anaphylaxis Induced by Glucocorticoids

Erdmann¹,

Abuzahra²,

Schroeder³

et al. 2005

The Journal of the American Board of Family Medicine

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“…The opposite may also occur; e.g. reactions to native hydrocortisone and methylprednisolone, but not to their corresponding sodium succinate salts (133).…”

Section: Immediate Reactionsmentioning

confidence: 99%

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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“…3 A catecholamine surge might be responsible for ventricular systolic dysfunction. 4,5 Stress-induced cardiomyopathy can manifest itself as global hypokinesia, different from typical apical ballooning. 6 The mild elevation in our patient's troponin levels was attributed to acute cardiac strain from anaphylaxis.…”

Section: To the Editormentioning

confidence: 99%

Single Coronary Artery

Sen

Astarcıoğlu

Parspur

et al. 2015

Texas Heart Institute Journal

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We wish to present the case of a 26-year-old woman who had a right temporo-occipital throbbing headache, vertigo, and numbness in the right hand and right side of the face. Brain images revealed no acute intracranial pathologic condition, so she was given sodium succinate-containing intravenous methylprednisolone for complicated migraine. Within 20 minutes, a diffuse erythematous urticarial rash developed on her face and chest, accompanied by respiratory distress. Her vital signs were: temperature, 98.8 °F; blood pressure, 101/59 mmHg; pulse rate, 118 beats/min; respiratory rate, 28 breaths/min; and oxygen saturation, 70% on room air. Intramuscular epinephrine and intravenous diphenhydramine were ineffective, so she was intubated. Her peak troponin I level was 0.72 ng/mL, and her B-type natriuretic peptide level was 881 pg/mL (vs 6 pg/mL at baseline). Chest images revealed substantial pulmonary edema. A transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 0.20, severe global LV hypokinesis, and akinesia of the anteroseptal wall. A day earlier, her LVEF had been 0.55 with normal LV systolic function. She was given intravenous furosemide, diphenhydramine, and famotidine, and was weaned from mechanical ventilation. Five days later, TTE showed normal LV function.Our patient developed a diffuse rash in the setting of respiratory distress minutes after receiving intravenous methylprednisolone, pointing to an immediate hypersensitivity reaction. Succinate-containing intravenous corticosteroids are known to cause anaphylactic reactions. 1,2 The pathogenesis is enigmatic. A few studies implicate the degradation products of corticosteroids; others point to the high protein affinity of the succinate molecule, which in turn presents the steroid as an antigen. 1 Mast cells throughout the heart and mediators released by them are thought to depress cardiac function. 3 The cardiac mast cells release renin, which activates the cardiac renin angiotensin system to form angiotensin II. Angiotensin II activates angiotensin 1 receptors on nerve endings and promotes local noradrenalin secretion. 3 A catecholamine surge might be responsible for ventricular systolic dysfunction. 4,5 Stress-induced cardiomyopathy can manifest itself as global hypokinesia, different from typical apical ballooning. 6 The mild elevation in our patient's troponin levels was attributed to acute cardiac strain from anaphylaxis. The reversion of LV dysfunction to baseline within 5 days illustrates the reversible nature of this cardiomyopathy. Hemal Single Coronary ArteryTo the Editor: Njeim and colleagues 1 reported on a patient in whom the common trunk arising from the right coronary sinus gave rise to all coronary arteries that supplied the myocardium. This anomaly is called single coronary artery. The authors stated that, after the large common trunk, a right coronary artery (RCA) coursed along the atrioventricular groove and gave rise to the left circumflex coronary artery (LCx). They also indicated that the right v...

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Anaphylaxis-like reactions to corticosteroid therapy

Cited by 111 publications

References 6 publications

Anaphylaxis Induced by Glucocorticoids

Anaphylaxis Induced by Glucocorticoids

Allergic hypersensitivity to topical and systemic corticosteroids: a review

Single Coronary Artery

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