title: Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review.
abstract: Respiratory type-IV hypersensitivity reactions due to corticosteroids is a rare phenomenon. We describe two such cases. The first is a 37- year-old atopic woman who developed labial angioedema and nasal itching after the use of budesonide nasal spray. A month later, after the first puffs of a formoterol/budesonide spray prescribed for asthma, she noticed symptoms of tongue and oropharyngeal itching and redness with subsequent dysphagia, labial and tongue angioedema, and facial oedema. The second is a 15-year-old non-atopic woman who reported pruritic eruptions around the nostrils after using a budesonide nasal spray. A year later she presented with nasal pruritus with intense congestion and labial and facial oedema after using the same spray. Both patients were evaluated with patch-tests using the commercial T.R.U.E. test, a budesonide solution, and corticosteroid creams. Test evaluation was performed at 48 and 96 hours. In both patients, patch tests were positive to budesonide (++) on the second day. The first patient also had a positive (+) reaction to tixocortol-21-pivalate. All the other patch tests were negative. Clinicians should be aware that hypersensitivity reactions may occur during the use of nasal or inhaled corticosteroids.
authors.affiliation: Allergy Outpatient Department, Social Insurance Institute, Athens, Greece. pitsios@yahoo.com
authors.forename: Constantinos
authors.initials: C
authors.lastname: Pitsios
authors.forename: Efthalia C
authors.initials: EC
authors.lastname: Stefanaki
authors.forename: Arthur
authors.initials: A
authors.lastname: Helbling
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D019819:Budesonide / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010328:Patch Tests; D012130:Respiratory Hypersensitivity / Q000139:chemically induced*
chemical_list: D018927:Anti-Asthmatic Agents; D019819:Budesonide