Corticosteroid hypersensitivity studies in a skin allergy clinic.
BACKGROUND
Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic.


METHODS
Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period.


RESULTS
We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction.


CONCLUSIONS
The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids.
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España. Electronic address: lauraberbegal@gmail.com.
L
L
Berbegal
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
F J
FJ
DeLeon
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
J F
JF
Silvestre
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000737:chemistry / Q000145:classification; D000328:Adult; D000368:Aged; D000486:Allergy and Immunology; D019819:Budesonide / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology / Q000209:etiology; D009783:Dermatitis, Occupational / Q000453:epidemiology / Q000209:etiology; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006229:Hand Dermatoses / Q000453:epidemiology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000453:epidemiology*; D006969:Hypersensitivity, Immediate / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015394:Molecular Structure; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010328:Patch Tests; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
D000305:Adrenal Cortex Hormones; D019819:Budesonide
Allergic contact dermatitis; Batería estándar; Corticoides; Corticosteroids; Dermatitis de contacto alérgica; Patch tests; Pruebas epicutáneas; Standard series