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Kim, Sohn, Lee, Kang, Lee, and Kang: Immediate hypersensitivity reaction to steroids: a case report
Case Report

Allergy Asthma Respir Dis 2017;5(3):165-168.

Published online: 5 May 2017

DOI: https://doi.org/10.4168/aard.2017.5.3.165

Immediate hypersensitivity reaction to steroids: a case report

Eun Ji Kim1, Kyoung-Hee Sohn2, 3, Jin Lee4, Dong Yoon Kang4, Ju-Yeun Lee1, Hye-Ryun Kang2, 3, 4

1College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Seoul, Korea

2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

3Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea

4Seoul National University Hospital Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea

Correspondence to: Hye-Ryun Kang https://orcid.org/0000-0002-2317-4201 Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0820, Fax: +82-2-742-3291, E-mail: helenmed@snu.ac.kr

• This research was supported by a grant from Ministry of Food and Drug Safety to operation of the regional pharmacovigilance center in 2016.

Received 11 August 201625 October 2016       Accepted 7 November 2016

Copyright © 2017 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Steroids are widely used for the treatment of a variety of diseases, including autoimmune and allergic diseases. Immediate hyper-sensitivity reactions can occur within 1 hour after administration of steroids and are regarded as IgE-mediated hypersensitivity pre-senting as urticaria, angioedema, bronchospasm, and anaphylaxis. Steroid hypersensitivity is rare, but can be life-threatening. Therefore, it is important to find implicated drugs and to choose safe alternative agents. A 44-year-old female was diagnosed with steroid hypersensitivity after intralesional steroid injection. She underwent a skin prick test and an intradermal test for methylprednisolone, triamcinolone, hydrocortisone, and dexamethasone. The results were positive to triamcinolone and methylprednisolone. The patient was educated to avoid culprit agents in order to prevent recurrence. Herein, we report a rare case of steroid hypersensitivity that showed positive reactions to triamcinolone and methylprednisolone. A review of the literature for steroid hypersensitivity is also provided.

Keywords: Drug hypersensitivity, Steroids, Skin tests

REFERENCES

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Fig. 1.
The structure of hydrocortisone.
aard-5-165f1.tif
Table 1.
The result of skin prick test with various steroids
Steroid Skin prick test
   Intradermal test
Concentration (mg/mL) Wheal size (mm×mm) Concentration (mg/mL) Bleb size (mm×mm) Wheal size (mm×mm)
Histamine 1.7 5×5 N/A - -
Normal saline 9 0×0 N/A - -
Dexamethasone 5 0×0 0.05 3×3 -
      0.5 3×3 -
Triamcinolone 40 10×23 N/A N/A -
Methylprednisolone 40 0×0 0.4 3×3 -
      4 3×3 5×10
Hydrocortisone 100 0×0 1 3×3 -
      10 3×3 -

N/A, not assessed.

Table 2.
Classes of corticosteroids
A B C D
D1 D2
Hydrocortisone Triamcinolone Betamethasone Clobetasone-17-butyrate Hydrocortisone-17-propionate
Prednisolone Fluocinolone Dexamethasone Clobetasol-17-propionate Hydrocortisone-17-butyrate
Methylprednisolone Halcinonide Desoximetasone Beclomethasone dipropionate Methylprednisolone aceponate
Cortisone acetate Desonide Fluocortolone Betamethasone valerate Prednicarbate
Prednisone Fluocinonide   Betamethasone dipropionate  
Tixocortol pivalate Budesonide      
Table 3.
Reported cases of hypersensitivity to steroids in literature1-11
Implicated drug (No. of subjects) Age (yr), mean±SD Male sex (No. of subjects) Clinical manifestations (No. of cases)
Methylprednisolone (n=37) 31.24±20.51 20 Anaphylaxis (28), urticaria (10), urticarial/angioedema (3), angioedema (1), bronchospasm (dyspnea (1), rash (1)
Triamcinolone (n=18) 32.64±26.38 10 Anaphylaxis (17), urticaria (1)
Prednisolone (n=13) 9.00±6.53 6 Anaphylaxis (4), urticaria (4), rash (2), urticaria /angioedema (1), angioedema (1), dyspnea (1)
Hydrocortisone (n=8) 44.00±29.90 1 Anaphylaxis (3), urticaria (2), urticarial/angioedema (1), urticarial/angioedema/vomiting (acute itchy/maculopapular eruption (1)
Prednisone (n=6) 8.17±5.19 3 Anaphylaxis (2), urticaria (2), rash (2)
Betamethasone (n=6) 50.50±25.38 3 Anaphylaxis (5), nausea/vomiting/paroxysmal cough/fecal incontinence (1)
Dexamethasone (n=3) 62.60±17.33 1 Anaphylaxis (3), urticaria (1), urticaria/angioedema (1)
Deflazacort (n=1) 37 0 Anaphylaxis (1)
Fluticasone (n=1) 38 1 Anaphylaxis (1)
Mometasone (n=1) 10 1 Anaphylaxis (1)

SD, standard deviation.

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