Immediate allergic reaction to methylprednisolone with tolerance of other corticosteroids

Atanasković-Marković, Marina; Gavrović-Jankulović, Marija; Janković, Srdja; Blagojevic, Gordan; Veličković, Tanja Ćirković; Milojević, Irina; Simić, Dušica; Nestorovic, Branimir

doi:10.2298/sarh1204233a

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…Initial testing with higher dilutions and slow titration to regular test concentration are generally recommended . Most of the data in current recommendations arise from adult studies with only few data specific for children are published . However, differences between children and adults have been highlighted.…”

Section: Diagnosismentioning

confidence: 99%

“…63 Most of the data in current recommendations arise from adult studies with only few data specific for children are published. 64,65 However, differences between children and adults have been highlighted. For example, the rate of systemic reaction during skin testing with beta-lactams has been found to be lower in children than in adults, and several reference centers used directly the full dose for skin testing.…”

Section: Confirming or Identifying A Druginduced Triggermentioning

confidence: 99%

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Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Atanasković-Marković

Gomes

Cernadas³

et al. 2019

Pediatric Allergy Immunology

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Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life‐threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug‐induced anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non‐steroidal anti‐inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children remains not well defined for a significant number of the drugs. Generally, a drug provocation test is discussed to confirm or exclude an immediate‐onset drug‐induced hypersensitivity. Although avoidance of the incriminated drug (and related drug) is the rule, rapid desensitization is useful in selected subgroups of patients. There is a need for large, multicentric studies, to evaluate the real diagnostic value of the currently available skin tests. Moreover there is also a need to develop new diagnostic tests in the future to improve the management of these children.

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Section: Diagnosismentioning

confidence: 99%

Section: Confirming or Identifying A Druginduced Triggermentioning

confidence: 99%

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Atanasković-Marković

Gomes

Cernadas³

et al. 2019

Pediatric Allergy Immunology

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“…Those differences might be explained by geographical variations, different phenotypes, and ages of the patients, but also by inclusion of Non‐Immediate DHRs (NIDHRs) in which BAT is not useful. In addition, BAT has been scarcely investigated (case reports) for the diagnosis of allergy to vaccines and corticosteroids 102,103 . Although results suggest that BAT may be useful also in children, this needs confirmation in larger focused studies.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, BAT has been scarcely investigated (case reports) for the diagnosis of allergy to vaccines and corticosteroids. 102,103 Although results suggest that BAT may be useful also in children, this needs confirmation in larger focused studies. Moreover, it would be interesting to evaluate the value of BAT in different ages group with different viral disease implications.…”

Section: Bat In the Evaluation Of Pediatric Populationmentioning

confidence: 97%

Flow‐based basophil activation test in immediate drug hypersensitivity. An EAACI task force position paper

Mayorga,

Çelik,

Pascal

et al. 2023

Allergy

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Diagnosing immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge and there is an urgent need for safe and reliable tests. Evidence has emerged that the basophil activation test (BAT), an in vitro assay that mirrors the in vivo response, can be a complementary test for many drugs. In this position paper, members of Task Force (TF) “Basophil activation test in the evaluation of Drug Hypersensitivity Reactions” from the European Academy of Allergy and Clinical Immunology (EAACI) present the data from a survey about the use and utility of BAT in IDHRs in Europe. The survey results indicate that there is a great interest for using BAT especially for diagnosing IDHRs. However, there are still main needs, mainly in the standardization of the protocols. Subsequently consensus‐based recommendations were formulated for: (i) Technical aspects of BAT in IDHRs including type of sample, management of drugs, flow cytometry protocols, interpretation of the results; and (ii) Drug‐specific aspects that should be taken into account when performing BAT in relation to betalactams, neuromuscular blocking agents, fluoroquinolones, chlorhexidine, opioids, radio contrast media, chemotherapeutics, biological agents, nonsteroidal anti‐inflammatory drugs, COVID vaccine, and excipients. Moreover, aspects in the evaluation of pediatric population have also been considered. All this indicates that BAT offers the clinician and laboratory a complementary tool for a safe diagnostic for IDHRs, although its place in the diagnostic algorithm depends on the drug class and patient population (phenotype, geography, and age). The standardization of BAT is important for generalizing this method beyond the individual laboratory.

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“…These were mainly reported for local [2], intramuscular [3], oral [4], and inhalation [5] applications. Only a few cases report an anaphylactic reaction after intravenous administration of cortisone [6,7]. Therefore, we report for the first time the case of a systemic allergic reaction by a patient with OT treated with a single dose of intravenous prednisolone-21-hydrogensuccinate (Solu-Decortin® H) to reduce the ocular inflammatory response of OT.…”

Section: Introductionmentioning

confidence: 98%

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

et al. 2014

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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.

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Immediate allergic reaction to methylprednisolone with tolerance of other corticosteroids

Cited by 8 publications

References 12 publications

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Flow‐based basophil activation test in immediate drug hypersensitivity. An EAACI task force position paper

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

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