Anaphylaktischer Schock nach intravenöser Hydrokortisonsuccinatgabe

Abstract

Glucocorticoids are frequently used in clinical anaesthesiology and intensive care because of their antiallergic, antiinflammatory and antioedematous properties and anaphylactic reactions are rare. We report on a 62-year-old asthmatic patient with evidence of aspirin sensitivity. We administered 100 mg of hydrocortisone-21-hemisuccinate (Pharmacia & Upjohn, Erlangen, Germany) dissolved in 100 ml 0.9% sodium chloride solution for perioperative corticoid substitution. The patient immediately developed severe bronchospasm and anaphylactic shock requiring intubation and mechanical ventilation. He received adrenaline, isoflurane, ketamine and inhalational fenoterol. He then developed atrioventricular block type III for which we transcutaneously paced the patient. Subsequently he was tested via skin prick tests, intracutaneous tests and i.v.-challenges resulting in the patient having positive reactions to hydrocortisone-21-hemisuccinate. Thus when allergic-like reactions result from glucocorticoid therapy one should consider corticoid allergy as a differential diagnosis.

Effects of the pattern of glucocorticoid replacement on neural processing, emotional reactivity and well-being in healthy male individuals: study protocol for a randomised controlled trial

“…There is a rare possibility of an anaphylactic reaction [ 15 ] to parenteral hydrocortisone succinate administration in a subject with no prior history of anaphylaxis. All medical and biomedical procedures related to this study will occur in the Joint Clinical Research unit at UHB or the Clinical Research and Imaging Centre of the University of Bristol (CRICBristol).…”

Immediate-Type Hypersensitivity to Succinylated Corticosteroids

“…In recent years, immediate-type hypersensitivity reactions to succinylated corticosteroids have been described quite frequently [3,4,6,7,9,11,12,14,15,16,18,24,25,26,34,35,36,37,38,39,40,41] whereas such reactions to succinate-free corticosteroids seem to be less frequent [2,5,10,19,20,42,43,44]. A number of patients had positive skin prick tests to the eliciting and related corticoidsteroids [11,26,45,46].…”

“…The pathomechanism of these reactions has remained unclear in most patients, but positive skin test reactions or specific IgE antibodies to the suspected elicitors were found in some patients [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. Challenge tests were performed in just a few cases, and most of them were positive [5,8,14,18,19,20]. …”

Anästhesie bei allergischer Diathese

“…Ferner kann bei saisonalabhängigen Allergien, wie Heuschnupfen im Herbst und Winter, oder bei sicherer Antigenvermeidung (Insekten-und Schlangengiftallergie) auf eine Prämedikation mit H 1 -und H 2 -Antagonisten verzichtet werden. Da Kortisonpräparate selber anaphylaktische Reaktionen hervorrufen können [12,48], ist eine prophylaktische Gabe nur sehr selten unter strenger Indikationsstellung bei dokumentierten lebensbedrohlichen Anaphylaxien (Schweregrad IV) sinnvoll.…”