Anaphylactic reaction to intravenous corticosteroids in the treatment of ocular toxoplasmosis: a case report

Abstract

IntroductionThis case report presents for the first time an acute systemic allergic reaction to corticosteroids in a patient with ocular toxoplasmosis after treatment with intravenous cortisone, and discusses alternative treatments.Case presentationWe present the case of a 57-year-old Caucasian woman with an anaphylactic reaction after intravenous injection of prednisolone-21-hydrogensuccinate (Solu-Decortin® H) given for the treatment of toxoplasmosis-associated chorioretinitis. Immediately after the injection, she developed an acute erythema of the legs and abdomen, angioedema, hypotension (blood pressure 80/40mmHg), tachycardia (heart rate 140/minute), hyperthermia (38.8°C), and respiratory distress. Allergological examinations showed a positive skin-prick test to prednisolone and methylprednisolone. In addition, an oral exposure test with dexamethasone (Fortecortin®) and betamethasone (Celestamine®) was conducted to find alternative corticosteroids for future treatments. After oral application, no local or systemic reactions were observed for these two substances.ConclusionsThis case report demonstrates that systemic allergic reactions are possible in patients with uveitis or other inflammatory ophthalmological conditions treated with intravenous corticosteroids. Intravenous administration of cortisone, for example, in the treatment of ocular toxoplasmosis, should always be conducted with caution because of a possible allergic reaction. For patients who react to a particular steroid, it is necessary to undergo allergological testing to confirm that the compound in question is indeed allergenic, and to identify other corticosteroids that are safe for future anti-inflammatory treatments.

Medication contaminants as a potential cause of anaphylaxis to vincristine: What about drug‐specific antigens?

“…Furthermore, corticosteroids, drugs used to treat allergy, paradoxically can also induce anaphylactic reactions. 10 Indeed, in the report of Hill et al 1 four of their patients had received premedications (antihistamines ± steroids) prior to subsequent infusions.…”

“…However, H2‑antihistamines, such as cimetidine, famotidine, and ranitidine, and H1‑antihistamines, such as cetirizine, hydroxyzin, and pheniramine, can themselves induce severe anaphylactic reactions and shock, although rare. Furthermore, corticosteroids, drugs used to treat allergy, paradoxically can also induce anaphylactic reactions . Indeed, in the report of Hill et al .…”