'Empty sella syndrome': a case of a patient with sodium succinate hydrocortisone allergy.
OBJECTIVE
We present the case of a woman with 'empty sella syndrome' who experienced generalized urticaria after the administration of sodium succinate hydrocortisone in two episodes.


METHODS
The patient underwent an allergological evaluation (prick, intradermal, and patch tests) with hydrocortisone sodium succinate, hydrocortisone acetate, hydrocortisone, hydrocortisone sodium phosphate, methylprednisolone hemisuccinate, methylprednisolone, and preservatives held in the formulation of sodium succinate hydrocortisone (sodium phosphate and methyl-p-oxybenzoate). The basophil activation test (BAT) was also performed with hydrocortisone. The single-blind i.m. challenge test was performed with hydrocortisone sodium phosphate in 4 days.


RESULTS
Skin test with hydrocortisone sodium succinate and methylprednisolone hemisuccinate was positive. On the contrary, allergological tests performed with other formulations of the same steroids and preservatives were negative. These results showed an immediate-type allergy to succinate ester. BAT was not helpful to improve our diagnostic work-up because our patient was a 'nonresponder.' Therefore, the patient underwent successfully to a challenge test with hydrocortisone sodium phosphate.


CONCLUSIONS
Patients with succinate ester allergy can tolerate alternative corticosteroids without ester.
Nucera
Eleonora
E
Allergy Department, Catholic University, Policlinico 'A. Gemelli,' Largo F. Vito, 1-00168 Rome, Italy.
Lombardo
Carla
C
Aruanno
Arianna
A
Colagiovanni
Amira
A
Buonomo
Alessandro
A
de Pasquale
Tiziana
T
Pecora
Valentina
V
Sabato
Vito
V
Rizzi
Angela
A
Pascolini
Lucilla
L
Ricci
Anna Giulia
AG
Schiavino
Domenico
D
D018926:Anti-Allergic Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000627:therapeutic use; D003875:Drug Eruptions / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D004638:Emergency Treatment / Q000379:methods; D004652:Empty Sella Syndrome / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007262:Infusions, Intravenous; D008875:Middle Aged; D012882:Skin Tests; D014581:Urticaria / Q000139:chemically induced* / Q000188:drug therapy
D018926:Anti-Allergic Agents; C039803:hydrocortisone sodium phosphate; D001623:Betamethasone; C007133:hydrocortisone hemisuccinate; D006854:Hydrocortisone