Tuesday, August 8, 2017

Allergy : Corticosteroid

  • Although allergic reactions to corticosteroids do occur, they are, in the vast majority of times, due to intravenous or intramuscular injection.
  • Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS
Systemic Steroids:
  • reactions occur more frequently in asthmatic subjects and in patients regularly treated with systemic CSs(e.g. in the case of a missing or transplanted kidney) than in other subjects. 
  • However, in these cases, it is difficult to determine whether the higher incidence of allergies observed is due to increased susceptibility, or to greater exposure to CSs.
  • Other factors such as hypersensitivity to salicylic acid might also constitute risk factors ; neither can genetic predisposition to CS allergies be excluded
Topical Steroids
  • The incidence reported in the literature varies between 0.5% to 6%
  • People with chronic eczema who require multiple prescriptions of topical steroids are at increased risk of becoming sensitized to topical steroids
  • Risk factors for immediate corticosteroids allergy
    • Patients requiring repeated doses of steroids e.g., renal transplant patients, severe asthmatics
    • Aspirin sensitivity
    • Female sex
  • Risk factors for allergic contact dermatitis (delayed hypersensitivity) to corticosteroids
    • Chronic nonhealing dermatitis / eczema
    • Stasis dermatitis
    • Chronic hand eczema
    • Having allergic contact dermatitis to other chemicals
Cross Reactivity
  • There is an antigenic classification of corticosteroids based on their cross-reactivity related to contact dermatitis reactions. 
  • Although this deals with delayed hypersensitivity, it could perhaps give one a guide as to what corticosteroid might exhibit the least chance of cross-reacting with 
  • Corticosteroids with lower risk of sensitization
    • Group C,
    • The metylated and halogenated members of Group D,
    • Newer synthetic steroids like Fluticasone propionate (cutivate) and mometasone furorate (Elocon) have a lower risk of sensitization

References:
  1. http://www.allergyclinic.co.nz/corticosteroid_allergy.aspx
  2. https://www.aaaai.org/ask-the-expert/allergic-reaction-prednisone
  3. https://www.ncbi.nlm.nih.gov/pubmed/23567983
  4. https://www.ncbi.nlm.nih.gov/pubmed/11456363
  5. Allergic hypersensitivity to topical and systemic corticosteroids:
    a review. 2009 John Wiley & Sons A/S Allergy 2009: 64: 978–994

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