Are the Spanish baseline series markers sufficient to detect contact allergy to corticosteroids in Spain? A GEIDAC prospective study

Abstract

SummaryBackground. Corticosteroids are among the most commonly used topical drugs. Contact allergy to these exists, but can be easily missed. Corticosteroid screening markers have been included in the baseline series with the aim of detecting most of the sensitized patients. Objectives. To assess the prevalence of contact allergy to topical corticosteroids in Spain and examine the usefulness of corticosteroid markers to detect contact allergy to corticosteroids. Methods. In total, 3699 patients referred to 20 dermatology departments across Spain for patch testing with the baseline series, including budesonide and tixocortol pivalate, were also tested with six supplementary corticosteroids (methylprednisolone aceponate, mometasone furoate, prednicarbate, clobetasol propionate, betamethasone 17-valerate, and betamethasone 17,21-dipropionate). Additionally, 2547 (68.8%) patients were tested with hydrocortisone 17-butyrate. Results. Fifty-four patients showed positive reactions to at least one of all tested corticosteroids (1.46%). Thirty-nine (1.05%) reacted to at least one of the additionally tested corticosteroids; among these, 24 of 39 (61.5%) did not react to any of the corticosteroid allergy screening markers tested. Conclusions. More than half of the patients who were allergic to the additionally tested corticosteroids were not detected with the corticosteroid allergy markers. An update of the corticosteroid allergy screening markers is encouraged, with consideration of group 3 corticosteroids.

Patch test results with the European baseline series and additions thereof in the ESSCA network, 2015‐2018

“…The fact that MI 0.02 and 0.05% aq. elicited a slightly higher share of positive reactions than MI 0.2% as recommended appears 41 In other words, the two EBS markers failed to detect corticosteroid allergy in about 40% of the patients in that study, which probably depends on country-or region-specific exposure/prescription. Of note, the Spanish study used a day 7 reading, which was mostly lacking in the present data, and in the outcome definition, which must be regarded as a shortcoming leading to underestimation of the sensitization prevalence particularly of the corticosteroids by up to 30%.…”

“…Overall, 1.46% (n = 54) showed a positive reaction to at least one of the eight corticosteroids and, among these, 39 to one of the six additional corticosteroids. Interestingly, 24 of those 39 were not positive to any of the two screening markers; hence, contact allergy would have been missed when relying solely on these 41 . In other words, the two EBS markers failed to detect corticosteroid allergy in about 40% of the patients in that study, which probably depends on country‐ or region‐specific exposure/prescription.…”

Patch testing of budesonide in Italy: The SIDAPA baseline series experience, 2018–2019

“…In the last 20 years, some studies focused on the prevalence of positive patch test reactions to budesonide 0.01% in consecutive patients, 8‐12 ranging from 1.8% in a North American study, 8 conducted in 2003–2004 in 5141 patients, to 0.6% in a Spanish study conducted in 2015–2016 in 3699 patients 12 …”

Kontaktallergien – Neu aufkommende Allergene und Auswirkungen für das Gesundheitswesen

“…Insgesamt zeigten 1,46 % der Patienten (n = 54) eine positive Reaktion auf mindestens eins der acht Kortikosteroide, davon 39 auf eins der sechs zusätzlich untersuchten. Bemerkenswerterweise waren 24 der 39 für keinen der beiden Screening-Marker positiv; bei deren alleiniger Betrachtung wären die Kontaktallergien also übersehen worden [187]. Doch egal wie umfangreich das Screening-Set der Kortikosteroide ist, wird die Diagnostik im Einzelfall die Substanzen umfassen müssen, die der Patient laut Anamnese nicht verträgt, außerdem idealerweise Haut- und Provokationstests (im Fall systemisch verabreichter Derivate) zu vermutlich nicht kreuzreaktiven Substanzen zur Bestätigung einer sicheren Alternative [188].…”