Hypersensivity Reactions to Steroids: Review

Abstract

The history of corticosteroids begins in the year of 1855 when Thomas Addison describes a "state of generalized languor, failure in the function of the heart, irritability in the stomach and changes of coloration in the skin", initially called melanodermia and later called Addison's disease, characterized by the lack of a substance produced in the adrenal glands [1].

Immediate and delayed hypersensitivity reactions to corticosteroids – prevalence, diagnosis and treatment

“…5). In vitro diagnostic tests, such as lymphocyte transformation or interferon-gamma (IFN-γ) assays, are not validated and are not available for clinical practice [9]. Skin prick tests (always negative) are useless for the diagnosis of delayed hypersensitivity to corticosteroids [38].…”

“…Because of the wide usage of corticosteroids, even uncommon allergic hypersensitivity reactions are clinically important, thus physicians (general practitioners as well as allergy and dermatology specialists) should be aware of such reactions. The allergic hypersensitivity reactions can be immediate (usually up to 1 hour after corticosteroid administration) or delayed (appearing after more than 1 hour up to several days after corticosteroid administration) [8][9][10][11][12]. Klim Gittelman et al and Borja et al reported immediate hypersensitivity reactions in 0.1-0.3% of patients under systemic corticosteroid treatment [13,14].…”

“…Delayed allergic hypersensitivity reactions to corticosteroids are mostly mediated by T cells (type IV response) [8,19]. It appears that binding of the corticosteroids (or their degradations products) to cutaneous or serum proteins generate stable antigens (allergens), which stimulate the immune system towards an allergic (type I immediate and type IV delayed hypersensitivity reactions) response [8,9]. As discussed below, the allergic response may be directed not only against the culprit corticosteroid agent, but also against other corticosteroids of the same class, although cross-reactivity between different corticosteroid classes was also reported (see table 1) [46] Glucocorticoids are classified according to chemical structure and side chains.…”