Immediate-type hypersensitivity to succinylated corticosteroids.
BACKGROUND
Despite their frequent use, systemic corticosteroids have rarely elicited immediate-type reactions.


OBJECTIVE
We report two male patients, aged 26 and 70 years, respectively, with severe immediate-type hypersensitivity secondary to the administration of corticosteroids esterified with succinate.


METHODS
Skin tests, basophil activation tests and challenge tests were performed for diagnostic evaluation.


RESULTS
In both patients, immediate-type skin test reactions were found to methylprednisolone sodium hemisuccinate (MSH) and prednisolone sodium hemisuccinate (PSH). In contrast, nonsuccinylated corticosteroids (including methylprednisolone and prednisolone in one patient) yielded no test reactions. Basophils from one patient exhibited a stimulated expression of the activation marker CD63 upon in vitro incubation with PSH or hydrocortisone sodium succinate, but not with hydrocortisone. Skin tests and basophil activation tests were negative in controls. One patient was challenged with the incriminated drugs. He developed flush, conjunctivitis, tachycardia and dyspnea 2 min after injection of MSH, and dyspnea shortly after intravenous administration of PSH. Oral and intravenous challenge tests with nonsuccinylated corticosteroids were tolerated well by both patients.


CONCLUSIONS
These case reports should alert clinicians to rare, but severe immediate-type reactions to corticosteroids, related to the succinate moiety in our patients. In case of allergic reactions to corticosteroids, it is mandatory to identify the causative agent and find safe alternatives.
Klinik und Poliklinik für Dermatologie und Allergologie, AllergieZENTRUM, Ludwig-Maximilians-Universität, München, Deutschland. annett.walker@med.uni-muenchen.de
Annett Isabel
AI
Walker
Helen-Caroline
HC
Räwer
Wolfgang
W
Sieber
Bernhard
B
Przybilla
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology / Q000276:immunology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D015549:Basophil Degranulation Test; D004342:Drug Hypersensitivity / Q000209:etiology / Q000276:immunology*; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology / Q000627:therapeutic use; D006969:Hypersensitivity, Immediate / Q000209:etiology / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000188:drug therapy; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology / Q000627:therapeutic use; D012882:Skin Tests; D013386:Succinates / Q000009:adverse effects / Q000276:immunology
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D013386:Succinates; D007073:Immunoglobulin E; D008776:Methylprednisolone Hemisuccinate; D011239:Prednisolone; C021322:prednisolone hemisuccinate; C007133:hydrocortisone hemisuccinate; D006854:Hydrocortisone