Delayed systemic allergic reactions to corticosteroids

Abstract

From the limited number of reports in the literature, it would appear that various types of delayed reactions from systemically, intralesionally, and intra-articularly administered corticosteroids are rare, particularly given their widespread use. The purpose of this literature review is to summarize in table form the reported cases of generalized delayed systemic corticosteroid reactions with respect to patient presentation, methods of evaluation, and conclusions reached. In total, 24 cases of generalized delayed systemic corticosteroid reactions have been reported in the literature. Clinical presentation (timing and cutaneous manifestations) as well as evaluation of these patients has been variable; reactions reported include eczematous or exanthematous eruptions, with or without bullae or purpura. In 16 cases, the diagnoses have been supported by positive patch or intradermal testing. Overall, it appears that generalized delayed systemic reactions to corticosteroids show considerable variability and are infrequently reported. Patch and intradermal tests with standardized allergens appear to be the most useful tests currently available to support this clinical diagnosis.

Delayed Generalized Allergic Reactions to Corticosteroids

“…Particularly the topical application on skin and mucous membranes may induce contact sensitization which may later result in disseminated or generalized eczematous reactions upon local, oral or parenteral reexposure [4, 5]. The importance of these drugs in emergency therapy requires a detailed diagnostic procedure to identify safe alternative corticosteroids.…”

Anaphylaktischer Schock nach intravenöser Hydrokortisonsuccinatgabe

“…Schwere anaphylaktische Reaktionen mit systemischen Symptomen wie Bronchospasmus oder Blutdruckabfällen innerhalb 5 min nach Gabe wurden in etwa 32 Fällen publiziert [4,5,11,19]. Des Weiteren gibt es Fallberichte, bei denen die allergische Reaktion erst nach 10 min bis Tage nach Applikation auftraten [24]. Diese verzögerten Reaktionen verlaufen meist weniger schwer.…”

“…Diese verzögerten Reaktionen verlaufen meist weniger schwer. Hautmanifestationen und Ödeme sind die vorherrschenden Symptome [11,24].…”

“…Hypersensitivitätsreaktionen können entweder als IgE-vermittelte Sofortreaktion (Typ I nach Coombs and Gell) auftreten [2,5,10],wie sehr wahrscheinlich im geschilderten Fall, oder häufiger als verzögerte Reaktion (Typ IV) [3,13,24,25]. Ein Teil der Reaktionen ist möglicherweise nicht allergisch bedingt [5,8,11].…”

Editorial comment

“…A group of drugs that have been implicated in the induction of both immediate and delayed allergic reactions are corticosteroids [9,10]. Although most commonly reported reactions are contact eczema followed by exanthema [11], anaphylactic reactions have also been reported [12].…”