Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review

Abstract

Respiratory type-IV hypersensitivity reactions due to corticosteroids is a rare phenomenon. We describe two such cases. The first is a 37-year-old atopic woman who developed labial angioedema and nasal itching after the use of budesonide nasal spray. A month later, after the first puffs of a formoterol/budesonide spray prescribed for asthma, she noticed symptoms of tongue and oropharyngeal itching and redness with subsequent dysphagia, labial and tongue angioedema, and facial oedema. The second is a 15-year-old non-atopic woman who reported pruritic eruptions around the nostrils after using a budesonide nasal spray. A year later she presented with nasal pruritus with intense congestion and labial and facial oedema after using the same spray. Both patients were evaluated with patch-tests using the commercial T.R.U.E. test ® , a budesonide solution, and corticosteroid creams. Test evaluation was performed at 48 and 96 hours. In both patients, patch tests were positive to budesonide (++) on the second day. The first patient also had a positive (+) reaction to tixocortol-21-pivalate. All the other patch tests were negative. Clinicians should be aware that hypersensitivity reactions may occur during the use of nasal or inhaled corticosteroids.

A case of systemic allergic dermatitis caused by inhaled budesonide: cross‐reactivity in patch tests with the novel inhaled corticosteroid ciclesonide

“…Our case indicates a delayed‐type allergic reaction to inhaled budesonide with a positive patch test result. Similar cases have been reported in the literature (5, 6). A corticosteroid allergy should be considered in patients receiving inhalation therapy with corticosteroids and appropriate symptoms (7).…”

Allergic Contact Dermatitis From Topical Drugs: An Overview

“…2 Application of nose drops or nasal spray may inter alia cause nasal itching, dryness, burning, nasal congestion, worsening of rhinitis, dysphagia, edema of the tongue, lips and face, dermatitis on the nose, upper lip, and face, and systemic contact dermatitis. [63][64][65][66] Local allergic adverse effects of inhaled CSs include stomatitis, perioral eczema, oropharyngeal pruritus, dryness, mouth erythema and edema, dry cough, dysphonia, dysphagia, odynophagia (pain when swallowing), dyspnea, and wheezing. [67][68][69] Symptoms often start early in the treatment (after several days) and may develop hours after inhalation.…”

Systemic allergic dermatitis due to budesonide patch testing

“…Budesonide is a glucocorticoid, widely used for the treatment of respiratory allergies. It may cause delayed hypersensitivity reactions and is therefore included in ready‐to‐use patch test panels, like the TRUE Test (SmartPractice, Hillerod, Denmark) 1‐3 . A distal reaction, not restricted to the patch test site is unusual 4 .…”