title: Clinical evaluation of anaphylactic reactions to intravenous corticosteroids in adult asthmatics.
abstract: BACKGROUND
  Corticosteroids form an important component of the treatment of acute asthma. Systemic anaphylactic reactions to intravenous corticosteroids have been reported, although their incidence is extremely rare.
  
  
  OBJECTIVE
  To determine the clinical features and underlying mechanisms of anaphylactic reactions to intravenous corticosteroids in adult asthmatics.
  
  
  METHODS
  The clinical features of 7 adult asthmatics (4 males, 3 females, mean age 39.4 +/- 16.9 years), who had developed systemic anaphylactic reactions to intravenous administration of corticosteroids for the treatment of acute asthma, were studied retrospectively on the basis of their medical records. Skin tests using various injectable steroid preparations were performed in 3 cases to determine the mechanism of this reaction.
  
  
  RESULTS
  Systemic anaphylactic reactions to intravenous administration of corticosteroids occurred in severe atopic asthmatics with previous exposure to parenteral corticosteroids, irrespective of age and gender. Aspirin-intolerant asthma was identified in only 3 subjects. In all cases, anaphylactic reactions were induced following intravenous administration of succinate-containing corticosteroid preparations, i.e. hydrocortisone and methylprednisolone. Administration of phosphate-containing corticosteroids, i.e. dexamethasone and betamethasone, was safe and resulted in a resolution of anaphylactic symptoms. Immunological examination with skin tests suggested that anaphylactic reactions were an IgE-mediated hypersensitivity.
  
  
  CONCLUSIONS
  Intravenous injection of succinate-containing corticosteroids in high-risk asthmatics should be performed slowly by drip injection under continuous monitoring. Once anaphylactic reactions occur, it is important to stop the injection immediately and to use conventional medication for anaphylaxis.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, Sakamoto, Nagasaki, Japan.
authors.forename: Hideyo
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hiroto
authors.initials: H
authors.lastname: Matsuse
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Obase
authors.forename: Kazuko
authors.initials: K
authors.lastname: Mitsuta
authors.forename: Shinya
authors.initials: S
authors.lastname: Tomari
authors.forename: Sachiko
authors.initials: S
authors.lastname: Saeki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawano
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kondo
authors.forename: Ikuko
authors.initials: I
authors.lastname: Machida
authors.forename: Terufumi
authors.initials: T
authors.lastname: Shimoda
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Asai
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids