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Hypersensitivity Reactions to Corticosteroids

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Abstract

Hypersensitivity reactions to corticosteroids (CS) are rare in the general population, but they are not uncommon in high-risk groups such as patients who receive repeated doses of CS. Hypersensitivity reactions to steroids are broadly divided into two categories: immediate reactions, typically occurring within 1 h of drug administration, and non-immediate reactions, which manifest more than an hour after drug administration. The latter group is more common. We reviewed the literature using the search terms “hypersensitivity to steroids, adverse effects of steroids, steroid allergy, allergic contact dermatitis, corticosteroid side effects, and type I hypersensitivity” to identify studies or clinical reports of steroid hypersensitivity. We discuss the prevalence, mechanism, presentation, evaluation, and therapeutic options in corticosteroid hypersensitivity reactions. There is a paucity of literature on corticosteroid allergy, with most reports being case reports. Most reports involve non-systemic application of corticosteroids. Steroid hypersensitivity has been associated with type I IgE-mediated allergy including anaphylaxis. The overall prevalence of type I steroid hypersensitivity is estimated to be 0.3–0.5 %. Allergic contact dermatitis (ACD) is the most commonly reported non-immediate hypersensitivity reaction and usually follows topical CS application. Atopic dermatitis and stasis dermatitis of the lower extremities are risk factors for the development of ACD from topical CS. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS. A close and detailed evaluation is required for the clinician to confirm the presence of a true hypersensitivity reaction to the suspected drug and choose the safest alternative. Choosing an alternative CS is not only paramount to the patient’s safety but also ameliorates the worry of developing an allergic, and potentially fatal, steroid hypersensitivity reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. The assessment should be done when the patient’s underlying condition is in a quiescent state.

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References

  1. Mumtaz IM, Hoyer BF, Panne D et al (2012) Bone marrow of NZB/W mice is the major site for plasma cells resistant to dexamethasone and cyclophosphamide: implications for the treatment of autoimmunity. J Autoimmun 39:180–188

    Article  CAS  PubMed  Google Scholar 

  2. Chang C, Gershwin ME (2010) Drugs and autoimmunity—a contemporary review and mechanistic approach. J Autoimmun 34:J266–J275

    Article  CAS  PubMed  Google Scholar 

  3. Hansel A, Gunther C, Baran W et al (2012) Human 6-sulfo LacNAc (slan) dendritic cells have molecular and functional features of an important pro-inflammatory cell type in lupus erythematosus. J Autoimmun 40:1–8

    Article  PubMed  Google Scholar 

  4. Cornec D, Devauchelle-Pensec V, Tobon GJ, Pers JO, Jousse-Joulin S, Saraux A (2012) B cells in Sjogren's syndrome: from pathophysiology to diagnosis and treatment. J Autoimmun 39:161–167

    Article  CAS  PubMed  Google Scholar 

  5. Matura M, Goossens A (2000) Contact allergy to corticosteroids. Allergy 55:698–704

    Article  CAS  PubMed  Google Scholar 

  6. Lutz ME, el-Azhary RA, Gibson LE, Fransway AF (1998) Contact hypersensitivity to tixocortol pivalate. J Am Acad Dermatol 38:691–695

    Article  CAS  PubMed  Google Scholar 

  7. Vind-Kezunovic D, Johansen JD, Carlsen BC (2011) Prevalence of and factors influencing sensitization to corticosteroids in a Danish patch test population. Contact Dermatitis 64:325–329

    Article  CAS  PubMed  Google Scholar 

  8. Lin CI, Yu HH, Lee JH et al (2012) Clinical analysis of macrophage activation syndrome in pediatric patients with autoimmune diseases. Clin Rheumatol 31:1223–1230

    Article  PubMed  Google Scholar 

  9. Rudd RJ, Fair KP, Patterson JW (2000) Aortic angiosarcoma presenting with cutaneous metastasis: case report and review of the literature. J Am Acad Dermatol 43:930–933

    Article  CAS  PubMed  Google Scholar 

  10. Abramson BL, Ruddy TD, deKemp RA, Laramee LA, Marquis JF, Beanlands RS (2000) Stress perfusion/metabolism imaging: a pilot study for a potential new approach to the diagnosis of coronary disease in women. J Nucl Cardiol 7:205–212

    Article  CAS  PubMed  Google Scholar 

  11. Casciola-Rosen L, Anhalt G, Rosen A (1994) Autoantigens targeted in systemic lupus erythematosus are clustered in two populations of surface structures on apoptotic keratinocytes. J Exp Med 179

  12. Bennett ML, Fountain JM, McCarty MA, Sherertz EF (2001) Contact allergy to corticosteroids in patients using inhaled or intranasal corticosteroids for allergic rhinitis or asthma. Am J Contact Dermat 12:193–196

    CAS  PubMed  Google Scholar 

  13. Kilpio K, Hannuksela M (2003) Corticosteroid allergy in asthma. Allergy 58:1131–1135

    Article  CAS  PubMed  Google Scholar 

  14. Kendall PH (1958) Untoward effects following local hydrocortisone injection. Ann Phys Med 4:170–175

    CAS  PubMed  Google Scholar 

  15. Dulloo AR, Ruddy FH, Congedo TV, Seidel JG, McIlwain ME (2000) Experimental verification of modeling results for a PGNAA system for nondestructive assay of RCRA metals in drums. Appl Radiat Isot 53:499–505

    Article  CAS  PubMed  Google Scholar 

  16. Borja JM, Galindo PA, Feo F, Gomez E (2001) Urticaria to methylprednisolone sodium hemisuccinate. Allergy 56:791

    Article  CAS  PubMed  Google Scholar 

  17. Sheth A, Reddymasu S, Jackson R (2006) Worsening of asthma with systemic corticosteroids. A case report and review of literature. J Gen Intern Med 21:C11–C13

    Article  PubMed Central  PubMed  Google Scholar 

  18. Polosa R, Prosperini G, Pintaldi L, Rey JP, Colombrita R (1998) Anaphylaxis after prednisone. Allergy 53:330–331

    Article  CAS  PubMed  Google Scholar 

  19. Laine-Cessac P, Moshinaly H, Gouello JP, Geslin P, Allain P (1990) Severe anaphylactoid reactions after intravenous corticosteroids. Report of a case and review of the literature. Therapie 45:505–508

    CAS  PubMed  Google Scholar 

  20. Baeck M, Marot L, Nicolas JF, Pilette C, Tennstedt D, Goossens A (2009) Allergic hypersensitivity to topical and systemic corticosteroids: a review. Allergy 64:978–994

    Article  CAS  PubMed  Google Scholar 

  21. Baeck M, Pilette C, Drieghe J, Goossens A (2010) Allergic contact dermatitis to inhalation corticosteroids. Eur J Dermatol 20:102–108

    CAS  PubMed  Google Scholar 

  22. Baeck M, De Potter P, Goossens A (2011) Allergic contact dermatitis following ocular use of corticosteroids. J Ocul Pharmacol Ther 27:83–92

    Article  CAS  PubMed  Google Scholar 

  23. Baeck M, Goossens A (2009) Patients with airborne sensitization/contact dermatitis from budesonide-containing aerosols 'by proxy'. Contact Dermatitis 61:1–8

    Article  CAS  PubMed  Google Scholar 

  24. Davis MD (2009) Unusual patterns in contact dermatitis: medicaments. Dermatol Clin 27:289–297, vi

    Article  CAS  PubMed  Google Scholar 

  25. Lutz ME, el-Azhary RA (1997) Allergic contact dermatitis due to topical application of corticosteroids: review and clinical implications. Mayo Clin Proc 72:1141–1144

    Article  CAS  PubMed  Google Scholar 

  26. Cervin A, Andersson M (1998) Intranasal steroids and septum perforation—an overlooked complication? A description of the course of events and a discussion of the causes. Rhinology 36:128–132

    CAS  PubMed  Google Scholar 

  27. Sohlenkamp C, de Rudder KE, Rohrs V, Lopez-Lara IM, Geiger O (2000) Cloning and characterization of the gene for phosphatidylcholine synthase. J Biol Chem 275:18919–18925

    Article  CAS  PubMed  Google Scholar 

  28. Poulos GA, Brodell RT (2007) Perioral dermatitis associated with an inhaled corticosteroid. Arch Dermatol 143:1460

    Article  PubMed  Google Scholar 

  29. Pirker C, Misic A, Frosch PJ (2003) Angioedema and dysphagia caused by contact allergy to inhaled budesonide. Contact Dermatitis 49:77–79

    Article  CAS  PubMed  Google Scholar 

  30. Cadinha S, Malheiro D, Rodrigues J, Castro E, Castel-Branco MG (2005) Delayed hypersensitivity reactions to corticosteroids. Allergol Immunopathol (Madr) 33:329–332

    Article  CAS  Google Scholar 

  31. Pitsios C, Stefanaki EC, Helbling A (2010) Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review. Prim Care Respir J 19:185–188

    Article  PubMed  Google Scholar 

  32. Oteri A, Bussolini A, Sacchi M, Clementi E, Zuccotti GV, Radice S (2010) A case of atrial fibrillation induced by inhaled fluticasone propionate. Pediatrics 126:e1237–e1241

    Article  PubMed  Google Scholar 

  33. Liu Y, Zhu H, Su Z et al (2012) IL-17 contributes to cardiac fibrosis following experimental autoimmune myocarditis by a PKCbeta/Erk1/2/NF-kappaB-dependent signaling pathway. Int Immunol 24:605–612

    Article  CAS  PubMed  Google Scholar 

  34. Buyuktimkin B, Wang Q, Kiptoo P, Stewart JM, Berkland C, Siahaan TJ (2012) Vaccine-like controlled-release delivery of an immunomodulating peptide to treat experimental autoimmune encephalomyelitis. Mol Pharm 9:979–985

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Ruddell DE, Thompson JY, Stoner BR (2000) Mechanical properties of a dental ceramic coated by RF magnetron sputtering. J Biomed Mater Res 51:316–320

    Article  CAS  PubMed  Google Scholar 

  36. Liu X, Li B, Wang W et al (2012) Effects of HMG-CoA reductase inhibitor on experimental autoimmune myocarditis. Cardiovasc Drugs Ther 26:121–130

    Article  CAS  PubMed  Google Scholar 

  37. Kang H, Freund C, Duke-Cohan JS, Musacchio A, Wagner G, Rudd CE (2000) SH3 domain recognition of a proline-independent tyrosine-based RKxxYxxY motif in immune cell adaptor SKAP55. EMBO J 19:2889–2899

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Walker AI, Rawer HC, Sieber W, Przybilla B (2011) Immediate-type hypersensitivity to succinylated corticosteroids. Int Arch Allergy Immunol 155:86–92

    Article  CAS  PubMed  Google Scholar 

  39. Samimi SS, Siegfried E (2002) Stevens–Johnson syndrome developing in a girl with systemic lupus erythematosus on high-dose corticosteroid therapy. Pediatr Dermatol 19:52–55

    Article  PubMed  Google Scholar 

  40. Erdmann SM, Abuzahra F, Merk HF, Schroeder A, Baron JM (2005) Anaphylaxis induced by glucocorticoids. J Am Board Fam Pract 18:143–146

    Article  PubMed  Google Scholar 

  41. Nahum A, Garty BZ, Marcus N, Shoenfeld T, Levy Y (2009) Severe hypersensitivity reactions to corticosteroids in children. Pediatr Emerg Care 25:339–341

    Article  PubMed  Google Scholar 

  42. Saito R, Moroi S, Okuno H, Ogawa O (2004) Anaphylaxis following administration of intravenous methylprednisolone sodium succinate in a renal transplant recipient. Int J Urol 11:171–174

    Article  PubMed  Google Scholar 

  43. Gelincik A, Yazici H, Emre T, Yakar F, Buyukozturk S (2009) An alternative approach to a renal transplant patient who experienced an immediate type systemic reaction due to methylprednisolone sodium succinate. J Investig Allergol Clin Immunol 19:162–163

    CAS  PubMed  Google Scholar 

  44. Lehmann S, Ott H (2008) Glucocorticoid hypersensitivity as a rare but potentially fatal side effect of paediatric asthma treatment: a case report. J Med Case Rep 2:186

    Article  PubMed Central  PubMed  Google Scholar 

  45. de Sousa NG, Santa-Marta C, Morais-Almeida M (2010) Systemic corticosteroid hypersensitivity in children. J Investig Allergol Clin Immunol 20:529–532

    PubMed  Google Scholar 

  46. Eda A, Sugai K, Shioya H et al (2009) Acute allergic reaction due to milk proteins contaminating lactose added to corticosteroid for injection. Allergol Int 58:137–139

    Article  PubMed  Google Scholar 

  47. Karsh J, Yang WH (2003) An anaphylactic reaction to intra-articular triamcinolone: a case report and review of the literature. Ann Allergy Asthma Immunol 90:254–258

    Article  PubMed  Google Scholar 

  48. Ventura MT, Calogiuri GF, Muratore L et al (2006) Cross-reactivity in cell-mediated and IgE-mediated hypersensitivity to glucocorticoids. Curr Pharm Des 12:3383–3391

    Article  CAS  PubMed  Google Scholar 

  49. Patterson DL, Yunginger JW, Dunn WF, Jones RT, Hunt LW (1995) Anaphylaxis induced by the carboxymethylcellulose component of injectable triamcinolone acetonide suspension (Kenalog). Ann Allergy Asthma Immunol 74:163–166

    CAS  PubMed  Google Scholar 

  50. Laing ME, Fallis B, Murphy GM (2007) Anaphylactic reaction to intralesional corticosteroid injection. Contact Dermatitis 57:132–133

    Article  CAS  PubMed  Google Scholar 

  51. Coopman S, Degreef H, Dooms-Goossens A (1989) Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids. Br J Dermatol 121:27–34

    Article  CAS  PubMed  Google Scholar 

  52. Goossens A, Matura M, Degreef H (2000) Reactions to corticosteroids: some new aspects regarding cross-sensitivity. Cutis 65:43–45

    CAS  PubMed  Google Scholar 

  53. Ventura MT, Calogiuri GF, Matino MG et al (2003) Alternative glucocorticoids for use in cases of adverse reaction to systemic glucocorticoids: a study on 10 patients. Br J Dermatol 148:139–141

    Article  CAS  PubMed  Google Scholar 

  54. Nakamura H, Matsuse H, Obase Y et al (2002) Clinical evaluation of anaphylactic reactions to intravenous corticosteroids in adult asthmatics. Respiration 69:309–313

    Article  CAS  PubMed  Google Scholar 

  55. Venturini M, Lobera T, del Pozo MD, Gonzalez I, Blasco A (2006) Immediate hypersensitivity to corticosteroids. J Investig Allergol Clin Immunol 16:51–56

    CAS  PubMed  Google Scholar 

  56. Aranda A, Mayorga C, Ariza A et al (2010) IgE-mediated hypersensitivity reactions to methylprednisolone. Allergy 65:1376–1380

    Article  CAS  PubMed  Google Scholar 

  57. Scott GS, Fishman S, Khai Siew L et al (2010) Immunotargeting of insulin reactive CD8 T cells to prevent diabetes. J Autoimmun 35:390–397

    Article  CAS  PubMed  Google Scholar 

  58. Tuzun E, Huda R, Christadoss P (2011) Complement and cytokine based therapeutic strategies in myasthenia gravis. J Autoimmun 37:136–143

    Article  PubMed  Google Scholar 

  59. Borchers AT, Leibushor N, Cheema GS, Naguwa SM, Gershwin ME (2011) Immune-mediated adverse effects of biologicals used in the treatment of rheumatic diseases. J Autoimmun 37:273–288

    Article  CAS  PubMed  Google Scholar 

  60. Schall N, Page N, Macri C, Chaloin O, Briand JP, Muller S (2012) Peptide-based approaches to treat lupus and other autoimmune diseases. J Autoimmun 39:143–153

    Article  CAS  PubMed  Google Scholar 

  61. Qureshi F, Zaritsky A, Poirier MP (2001) Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. J Pediatr 139:20–26

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA

    Rani R. Vatti, Fatima Ali, Suzanne Teuber & M. Eric Gershwin

  2. Division of Allergy, Asthma and Immunology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Christopher Chang

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  1. Rani R. Vatti
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  2. Fatima Ali
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  3. Suzanne Teuber
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  4. Christopher Chang
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  5. M. Eric Gershwin
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Correspondence to M. Eric Gershwin.

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Vatti, R.R., Ali, F., Teuber, S. et al. Hypersensitivity Reactions to Corticosteroids. Clinic Rev Allerg Immunol 47, 26–37 (2014). https://doi.org/10.1007/s12016-013-8365-z

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