Allergic contact dermatomucositis to budesonide

Iglesias-Cadarso, Alfredo; Diaz, Cesar; Laguna, José Julio; Hernandez-Weigand, Pilar

doi:10.1016/0091-6749(94)90214-3

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…Allergies to budesonide are rare, but have been published in the literature [ 9 ]. Budesonide causes mostly delayed type hypersensitivity reactions as experienced by our patient.…”

Section: Discussionmentioning

confidence: 99%

Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

et al. 2020

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Background Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that has been known since the early 1990s. Swallowed topical corticosteroids (STC) belong to the therapeutic cornerstones. We describe a delayed hypersensitivity reaction to Jorveza®, a newly developed orodispersible budesonide tablet licensed for the treatment of eosinophilic esophagitis. Case presentation A 32-year-old Caucasian woman with EoE was newly treated with Jorveza®. Hours after the first intake, she felt a “strange pruritus” in the throat. This sensation worsened with each subsequent intake. On day 4 she developed oral mucosal symptoms (paresthesia of the tongue, sore and an itchy throat). Intraoral, throat and facial swellings, but no systemic reaction were observed. Patch testing using two commercial test series as well as the orodispersible budesonide tablet revealed a strong sensitization, proving a T cell mediated allergy to budesonide. Conclusions Orodispersible budesonide is increasingly prescribed for the treatment of eosinophilic esophagitis. The development of oropharyngeal symptoms after initiating should alert the treating physician to the possibility of a hypersensitivity reaction.

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“…Allergies to budesonide are rare, but have been published in the literature [ 9 ]. Budesonide causes mostly delayed type hypersensitivity reactions as experienced by our patient.…”

Section: Discussionmentioning

confidence: 99%

Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

et al. 2020

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“…Various steroids differ in their ability to induce conNasal Septal Perforations and Contact Allergy tact allergy. For instance, budesonide seems more likely to induce contact allergy than novel steroids like momethasone [8]. However, in most cases contact allergy seems to be restricted to the skin, whereas mucosal contact allergies are very rare [11], although a case report concerning contact allergy to topical glucocorticosteroids and the development of a septal perforation has been described [7].…”

Section: Discussionmentioning

confidence: 99%

“…The present study was a further investigation trying to elucidate whether contact allergy might be a mechanism responsible for the development of septal perforations [7][8][9]. It is a well-known clinical observation that patients may become sensitized to topical glucocorticosteroids [9,11].…”

Section: Discussionmentioning

confidence: 99%

“…Septal perforation may be neglected, but it is nevertheless the most commonly reported side effect of nasal steroids to the Medical Product Agency in Sweden. Previous case reports have shown mucosal contact sensitivity to topical glucocorticosteroids [7][8][9]. We, therefore hypothesized that contact allergy would be a cause among our patients with nasal septal perforations who had used nasal steroid sprays.…”

Section: Introductionmentioning

confidence: 99%

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Nasal Septal Perforations during Treatment with Topical Nasal Glucocorticosteroids Are Generally Not Associated with Contact Allergy to Steroids

Cervin¹,

Hansson

Greiff³

et al. 2003

ORL

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Background: Mucosal ulcers and perforations of the nasal septum are very rare and may have several underlying causes. Contact allergy to steroids has been suggested as a possible aetiological factor in patients who develop perforations during topical steroid use. Methods: We have identified 13 subjects with perforations of their nasal septum and concomitant topical nasal steroid use. In order to evaluate whether these patients had developed contact allergy to steroids they underwent patch testing with an extended steroid series. Results: None of the subjects displayed any positive reaction to the steroids. Conclusion: Sensitivity to glucocorticoids is a well-described phenomenon and may in selected subjects also be associated with local side effects to nasal sprays. However, contact allergy to steroids does not seem to be a general explanation for septal perforations in patients using nasal steroids.

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“…Allergic symptoms from mucous membranes have been reported more seldom. Adverse effects due to nasal corticosteroids containing budesonide or tixocortol pivalate have ranged from nasal congestion (24–26), pruritus (27–29), nasal burning (27,29), soreness in the nasal cavity (30), and worsening of rhinitis (27,31,32) to perforation of the nasal septum (33). Inhalation corticosteroids intended for pulmonary use have been implicated in pruritus, dryness, erythema, and edema of the mouth (27); a dry cough (34); and odynophagia (27,35).…”

Section: Exposurementioning

confidence: 99%

Corticosteroids

Isaksson

2004

Dermatol Ther

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Up to 5% of dermatitis patients are allergic to corticosteroids. Because such allergy may be difficult to suspect due to the anti-inflammatory action of the corticosteroid, markers for corticosteroid allergy should be present in any standard series. Budesonide and tixocortol pivalate are two such markers, and they seem to detect a majority of corticosteroid allergy. The patch test concentration for a given corticosteroid may be crucial. A false-negative reaction may follow despite the patient being allergic, if too high a test concentration is used, because of the anti-inflammatory action of the corticosteroid. Patch test readings must be performed not only on Day 3 or Day 4 but also on a late occasion, i.e., Day 7 after test application, also because the anti-inflammatory action may suppress an allergic reaction at an early reading. Once a patient has reacted to a corticosteroid, an extended corticosteroid series should be tested, so that information may be given on which corticosteroids to use and, above all, which corticosteroids to avoid.

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Allergic contact dermatomucositis to budesonide

Cited by 12 publications

References 8 publications

Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

Nasal Septal Perforations during Treatment with Topical Nasal Glucocorticosteroids Are Generally Not Associated with Contact Allergy to Steroids

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