Contact allergy to corticosteroids

Matura, Mihály; Goossens, An

doi:10.1034/j.1398-9995.2000.00121.x

Cited by 147 publications

(129 citation statements)

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“…1) to form antigen (3,4). Clinically, it has been shown that positive patch test reactions to corticosteroid are correlated with patch test reactions to the corresponding corticosteroid-glyoxal (5,6). This suggests that the corticosteroid-glyoxal degradation product is involved in corticosteroid allergy.…”

mentioning

confidence: 99%

Corticosteroid cross‐reactions: an alternative view

Wilkinson

2000

Contact Dermatitis

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An alternative view of corticosteroid cross-reactivity is proposed, based on 2 immune recognition sites on the corticosteroid molecule, 1 influenced by C 6/9 substitution and 1 by C 16/17 substitution. A case report is adduced in support of such a hypothesis.Key words: corticosteroid; cross-reaction; allergic contact dermatitis; tixocortol pivalate; hydrocortisone; budesonide; medicaments; structure-activity relationships. C Munksgaard, 2000. Accepted for publication 9 August 1999Cross-reactions occur between chemicals with similar structures. However, structure is not the only determinant of whether such a reaction will occur (1, 2). On the skin, penetration of the allergen determines whether the immune system will be exposed, and if the substance is a prohapten, its susceptibility to metabolism or degradation determines whether antigen is formed. Metabolism and DegradationThe available evidence suggests that with corticosteroids, the allergen is not the steroid itself but a degradation product. Metabolism and degradation within the skin might therefore be a factor that influences the development of a cross-reaction. It has been suggested that corticosteroids degrade to a reactive corticosteroid-glyoxal that then reacts with arginine ( Fig. 1) to form antigen (3, 4). Clinically, it has been shown that positive patch test reactions to corticosteroid are correlated with patch test reactions to the corresponding corticosteroid-glyoxal (5, 6). This suggests that the corticosteroid-glyoxal degradation product is involved in corticosteroid allergy. In vitro, the amount of degradation product, which subsequently reacted with arginine, has been shown to vary between corticosteroids and to be correlated with the frequency of allergic reactions to a steroid (7).The corticosteroid-glyoxal is formed on the C17 side chain (Fig. 2). Alterations to this chain might therefore affect whether corticosteroid-glyoxal is formed. For practical purposes, the main alterations to this side-chain occur at the C21 position. In the skin, an esterase rapidly splits any ester from the molecule, resulting in a C21 hydroxyl group. In vivo, it has been estimated that within 5 h, 80% in rats, and 50% in dogs, of topically applied hydrocortisone-17-butyrate-21-propionate

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confidence: 99%

Corticosteroid cross‐reactions: an alternative view

Wilkinson

2000

Contact Dermatitis

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“…Other factors such as hypersensitivity to salicylic acid might also constitute risk factors (23); neither can genetic predisposition to CS allergies be excluded (24,25).…”

Section: Systemic Routementioning

confidence: 99%

“…The process of skin metabolism plays an important role in the allergenic potential of CSs and also influences their cross-reaction profiles (24). The cutaneous metabolic reactions involved in the biotransformation of CSs have not yet been fully determined.…”

Section: The Allergenic Capacity Of Cssmentioning

confidence: 99%

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Allergic hypersensitivity to topical and systemic corticosteroids: a review

Baeck

Marot

Nicolas

et al. 2009

Allergy

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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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“…De samme forhold gjør seg gjeldende for velkjente håndkjøps-preparater som krotamiton (Eurax) (2), bacitracin (Bacimycin) (3) og lidokain (4). Paradoksalt nok kan også håndkjøpspreparatet hydrokortison og andre lokale steroider føre til kontaktallergi, noe som er en virkelig utfordring for dermatologen (5).…”

Section: Når Behandlingen Er Problemet307unclassified

Når behandlingen er problemet

Holsen

2009

Tidsskriftet

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Contact allergy to corticosteroids

Cited by 147 publications

References 50 publications

Corticosteroid cross‐reactions: an alternative view

Corticosteroid cross‐reactions: an alternative view

Allergic hypersensitivity to topical and systemic corticosteroids: a review

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