Systemic Allergy to Corticosteroids: Clinical Features and Cross Reactivity

Title:Systemic Allergy to Corticosteroids: Clinical Features and Cross Reactivity

Volume: 22 Issue: 45

Author(s): Annick Barbaud and Julie Waton

Affiliation:

Keywords: Corticosteroids, allergy, drug reaction, cross-reaction, skin tests, chemical classification, skin test.

Abstract: Systemic hypersensitivity (HS) to corticosteroids (CS) is paradoxical but does exist. Some patients with a previous contact allergy to topical CS may develop a systemic contact dermatitis (SCD) while receiving CS orally or intravenously. However, a previous contact sensitization is not mandatory for developing a systemic HS to CS. Acute or delayed urticaria can occur in immediate HS. Immediate HS can be due to excipients, mainly carboxymethylcellulose or to CS themselves. Delayed reactions, mainly maculopapular rash and acute generalized exanthematous pustulosis can occur. Skin tests with systemic CS have to be standardized. It is necessary to determine if IDT with CS frequently induce skin atrophy or not and if such skin atrophy is transient by doing prospective studies using an standardized method and a limited injected volume (0.02 ml). Patch tests can be done in delayed HS, with readings at day 2, 4 and 7. In SCD, the Baeck’s classification of CS in 3 chemical groups could explain cross reactivity between systemic CS. However, this classification is not applicable to explain cross-reactions between in systemic HS. According to the literature, 52/79 patients had a HS reaction to a group confirmed by a positive allergological investigations, but had a negative provocation test with another CS belonging to the same group. In case of non-severe cutaneous adverse reactions and when skin tests are negative, provocation tests have to be performed to find an alternative CS, even if it belongs to the same chemical group as those responsible for the initial reaction.

Cite this article as:

Barbaud Annick and Waton Julie, Systemic Allergy to Corticosteroids: Clinical Features and Cross Reactivity, Current Pharmaceutical Design 2016; 22 (45) . https://dx.doi.org/10.2174/1381612822666161013092339