Corticosteroid contact allergy: an EECDRG multicentre study

Abstract

This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet., betamethasone-17-valerate 1% pet., clobetasol-17-propionate 1% pet., hydrocortisone-17-butyrate 1% eth., and tixocortol-21-pivalate 1% pet.; 189 (2.6%) gave a positive patchtest reaction (+, ++, + + +) to at least 1 of the corticosteroids. The data regarding the corticosteroid-sensitive patients, as well as the patchtest results, were recorded on a standardized form.

Contact allergy to corticosteroids

“…Indeed, patients suffering from atopic, allergic, and/or irritant contact dermatitis on the hands, as well as those suffering from stasis dermatitis/leg ulcers, often present with corticosteroid allergy (1). Occupational contact sensitization to topical corticosteroids may occur rarely in pharmacy work (25).…”

Allergic hypersensitivity to topical and systemic corticosteroids: a review

“…Patients who suffer from a long-term dermatological disease are at higher risk of sensitization when treated by topical CSs: these include chronic eczema, stasis dermatitis, chronic ulceration, chronic actinic dermatitis, facial, anogenital, and hand and foot dermatitis (17). Changes to the skin barrier and/or a local pro-inflammatory environment (favouring and priming antigen-presenting cells such as Langerhans cells) are the most likely determining factors.…”

“…The literature reports that the frequency of CS allergy following topical application ranges from 0.2% to 5% or more (3,17,26,27). Despite the wide use of inhaled CSs, very few cases of asthmatic patients experiencing allergic reactions have been reported (27, 28).…”

“…The principal markers for CS contact allergy are tixocortol pivalate (although not for skin use) (69,70), budesonide (17,71), and hydrocortisone 17-butyrate (72), the first two having been introduced to the European baseline series in the early 2000s (73). A slight difference between the sensitization rate to tixocortol pivalate (2-5%) and to budesonide (1-2%) is reported (3,17,26), but taken together, these two allergens are said to detect nearly 90% of CS-allergic patients (74), although this percentage depends on the number of patients tested and the CSs used to screen for contact allergy. The other CS preparations used by the patient should, however, also be tested, along with all other ingredients.…”

“…Especially when the concentration is high, the reaction may be falsely negative at early readings, because the anti-inflammatory effect can mask the allergic reaction. For this reason, numerous authors have proposed readings on day 6 or day 7, or even later (17,83).…”