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

Abstract

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.

Systemic allergic dermatitis due to budesonide patch testing

“…Three cases of systemic reactions after patch tests to budesonide have been reported, with concentrations of 1.0% pet 8 . or 0.1%.pet 9,10 . In one of these cases a mild itchy flexural exanthema developed overnight after test application, 10 whereas the others developed 2 days after patch testing 8,9 .…”

“…or 0.1%.pet 9,10 . In one of these cases a mild itchy flexural exanthema developed overnight after test application, 10 whereas the others developed 2 days after patch testing 8,9 . Systemic allergic dermatitis in response to corticosteroids is of infrequent occurrence, probably due to a counterbalance of their anti‐inflammatory action 4 …”

Eosinophilic Esophagitis—What Do We Know So Far?

“…An orodispersible budesonide tablet was introduced in 2018; this is the first drug for EoE treatment approved by the regulatory authorities in Europe but not in the United States [ 80 ]. Although allergies to budesonide are rare, it can have side effects in the form of delayed hypersensitivity reactions, which have been published in the literature [ 80 ]. Local complications of steroids are esophageal candidiasis, which occurs in 5–30% of patients, and oral candidiasis, which is far less common [ 34 ].…”