title: Type-IV hypersensitivity to betamethasone valerate and clobetasol propionate: results of a multicentre study.
abstract: BACKGROUND
  Most studies investigating steroid allergy have been performed with tixocortol pivalate, hydrocortisone butyrate and budesonide. Betnovate and Dermovate are widely prescribed in the U.K. but little is known about the frequency of sensitization to them.
  
  
  OBJECTIVE
  To determine the optimum method to detect contact allergy to betamethasone valerate (BV) and clobetasol propionate (CP).
  
  
  METHODS
  Seven centres tested consecutive patients attending for investigation of suspected allergic contact dermatitis to these steroids at a range of concentrations in different vehicles.
  
  
  RESULTS
  Of 1562 patients tested, 16 (1%) reacted to either BV or CP. Ten patients (0.7%) reacted to BV and 13 (0.8%) to CP. Two patients of a further centre were included in analysis of dilutions and vehicles. Sixteen of a total of 25 reactions (64%) were identified with a 1% dilution in ethanol.
  
  
  CONCLUSIONS
  Consideration should be given to adding BV and CP to a standard allergy series, given that both are frequently used in the treatment of eczema and that most patients sensitized to them are not identified with currently used markers of steroid allergy. If patch tests to BV and CP are initially negative, but an allergy is suspected, the patient should be further investigated. Further studies are required to identify the ideal patch test material.
authors.affiliation: Department of Dermatology, Leeds General Infirmary, Leeds LS1 3EX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sommer
authors.forename: S M
authors.initials: SM
authors.lastname: Wilkinson
authors.forename: J S C
authors.initials: JS
authors.lastname: English
authors.forename: D J
authors.initials: DJ
authors.lastname: Gawkrodger
authors.forename: C
authors.initials: C
authors.lastname: Green
authors.forename: C M
authors.initials: CM
authors.lastname: King
authors.forename: S
authors.initials: S
authors.lastname: Powell
authors.forename: J E
authors.initials: JE
authors.lastname: Sansom
authors.forename: S
authors.initials: S
authors.lastname: Shaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001507:Beclomethasone / Q000009:adverse effects*; D002990:Clobetasol / Q000009:adverse effects*; D003877:Dermatitis, Contact / Q000453:epidemiology* / Q000209:etiology; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D000431:Ethanol; D005188:False Negative Reactions; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D011237:Predictive Value of Tests; D015995:Prevalence
chemical_list: D005938:Glucocorticoids; D000431:Ethanol; D002990:Clobetasol; D001507:Beclomethasone