[Clinical significance of allergic reactions in glucocorticoid therapy].
BACKGROUND
Glucocorticoids are widely used in medicine. Within the last few years, however, patients have become very suspicious of corticoids. The attending physicians frequently has to use a great deal of persuasion prior to applying this very effective and often indispensable group of medication.


METHODS
We report on four patients who developed allergic reactions (i.e. erythema in face and on body, itching, flushing, drop in blood pressure, respiratory distress, cold sweats, etc.) immediately after intravenous administration of prednisolone-21 hydrogen succinate (Solu-Decortin H, SDH).


RESULTS
Three out of four patients had a positive reaction to an intracutaneous test with SDH, but no reaction to the additive sodium succinate. The prick test was negative in all patients. No specific IgE antibodies were detected in the serum of these patients. However allergic reaction to SDH must be presumed in at least three cases as it is difficult to detect glucocorticoid antibodies in serum and standardizes techniques are lacking. One female patient had a cross-reaction to prednisolon and dexamethasone. A renewed application of SDH was tolerated well by all patients when H1- and H2-receptors were blocked and calcium was administered to stabilize membranes.


CONCLUSIONS
Allergic reactions after glucocorticosteroid therapy are only occasionally mentioned in literature, appear more often when the agent is applied topically, and may lead to dangerous complications in patients if administered intravenously. Therefore, when allergic reactions result from glucocorticoid therapy (immediate reactions should be suspect), corticosteroid allergy should be considered as a differential diagnosis.
Alexiou
C
C
Hals-Nasen-Ohrenklinik, Klinikum rechts der Isar, Technischen Universität München.
Kau
R J
RJ
Luppa
P
P
Arnold
W
W
D000287:Administration, Topical; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D003429:Cross Reactions; D003875:Drug Eruptions / Q000209:etiology* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D003639:Hearing Loss, Sudden / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007262:Infusions, Intravenous; D007428:Intradermal Tests; D008575:Meniere Disease / Q000188:drug therapy / Q000276:immunology; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology; D012307:Risk Factors
D005938:Glucocorticoids; D007073:Immunoglobulin E; D011239:Prednisolone; C021322:prednisolone hemisuccinate
Klinische Bedeutung allergischer Reaktionen bei Glukokortikoidbehandlung.