METHODS: Retrospective analysis of medical records of patients with hypersensitivity to CS who attended a drug allergy outpatient clinic in a referral center from May 2014 to June 2017. Protocols for diagnostic tests were adapted from European Network on Drug Allergy.
RESULTS: Ten patients with history of hypersensitivity reaction to CS, 90% female, mean age 48 years, 70% atopic, were evaluated. All patients presented with cutaneous symptoms, and anaphylaxis occurred in 3 cases. In 80% of the patients, reactions were immediate, with symptoms occurring within 1 hour of administration of the drug. CS involved were betamethasone in 4 patients, dexamethasone and hydrocortisone in 3 each. All patients underwent skin testing (prick and intradermal) for suspicious and/or alternative drugs. Two patients underwent patch testing. Oral provocation tests and intravenous provocation tests were performed in 3 and 2 patients, respectively. Two patients were positive on intradermal testing (dexamethasone and hydrocortisone); and one patient on intravenous challenge testing (methylprednisolone and hydrocortisone), after being negative on skin tests.
CONCLUSIONS: Underdiagnosis is common because corticosteroids are used in the therapy of hypersensitivity disorders. Skin tests may provide evidence for an IgE-mediated mechanism in immediate hypersensitivity reactions to CS, and challenge tests are valuable tools to confirm a safe alternative. Early recognition, immediate treatment, and systematic research are critical in prognosis and safe choice of an alternative CS.