Immediate reactions to methylprenisolone with tolerace of other corticosteroids

“…A high tolerance to halogenated betamethasone and dexamethasone CSs in patients who are allergic to hydrocortisone and methylprednisolone was found in several studies (128,129,(134)(135)(136). With regard to immediate allergic reactions, two authors failed to detect any cross-reactivity between betamethasone and dexamethasone (agents with identical chemical structure, differing only in the position of the C16 methyl group) (137,138).…”

Section: Immediate Reactionsmentioning

confidence: 91%

Allergic hypersensitivity to topical and systemic corticosteroids: a review

Baeck

Marot

Nicolas

et al. 2009

Allergy

101

View full text Add to dashboard Cite

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.

show abstract

“…[2][3][4][5][6] Our patient with a history of an immediate type reaction to prednisolone and a positive skin test to the culprit agent provides additional evidence that immediate adverse reactions to systemic glucocorticoids do exist. Classifying adverse reactions to glucocorticoids, delayed type allergic reactions (contact dermatitis) after topical application have to be distinguished from immediate type reactions after systemic administration.…”

Section: Discussionmentioning

confidence: 99%

“…However, a few severe adverse reactions, including life-threatening reactions caused by systemic glucocorticoids, have been reported over the past decades. [2][3][4][5][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).…”

mentioning

confidence: 99%

Anaphylaxis Induced by Glucocorticoids

Erdmann¹,

Abuzahra²,

Schroeder³

et al. 2005

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

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...

show abstract

Immediate reactions to methylprenisolone with tolerace of other corticosteroids

Cited by 24 publications

References 5 publications

Immediate and delayed allergic hypersensitivity to corticosteroids: practical guidelines

Immediate and delayed allergic hypersensitivity to corticosteroids: practical guidelines

Allergic hypersensitivity to topical and systemic corticosteroids: a review

Anaphylaxis Induced by Glucocorticoids

Contact Info

Product

Resources

About