title: Patch testing to detect corticosteroid allergy: is it adequate?
abstract: Whilst patch testing with corticosteroids in ethanol is more sensitive than either petrolatum or the cream formulation, the frequency of false-negative reactions is not known. We have compared patch testing with corticosteroid at 1% in ethanol with intradermal (i.d.) tests using 1 mg corticosteroid suspended in normal saline. Patch tests with tixocortol pivalate and budesonide detected all patients allergic to hydrocortisone and budesonide, respectively. For other corticosteroids, the use of ethanol as a vehicle resulted in both false-positive and false-negative reactions. In particular, patch tests with hydrocortisone-17-butyrate missed 30% of all positive reactions detected by i.d. testing. There may be a case for advising the avoidance of this steroid in all patients who are positive on patch testing to tixocortol pivalate and budesonide.
authors.affiliation: Department of Dermatology, General Infirmary at Leeds, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Seukeran
authors.forename: S M
authors.initials: SM
authors.lastname: Wilkinson
authors.forename: M H
authors.initials: MH
authors.lastname: Beck
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D019819:Budesonide; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology*; D000431:Ethanol; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects* / Q000031:analogs & derivatives*; D007428:Intradermal Tests; D010328:Patch Tests / Q000379:methods*; D011282:Pregnenediones / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D012965:Sodium Chloride; D013535:Suspensions; D006113:United Kingdom
chemical_list: D000893:Anti-Inflammatory Agents; D011282:Pregnenediones; D013535:Suspensions; D000431:Ethanol; D012965:Sodium Chloride; D019819:Budesonide; D006854:Hydrocortisone