Hypersensitivity reaction to corticosteroids
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Orlando Trevisan Neto, Janaina Michelle Lima Melo, Mariana Paes Leme Ferriani, Thais Nociti De Mendonca, Ullissis Padua De Menezes, Débora Corazza Biazin, Julianne Alves Machado, Leilane Hoffman Nogueira, Luisa Karla P. Arruda, MD PhD FAAAAI
RATIONALE: Corticosteroids (CS) are widely used for the treatment of allergic, inflammatory and autoimmune diseases. There are few reports of hypersensitivity to CS.

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.