Immediate Hypersensitivity Reactions Induced by Triamcinolone in a Patient with Atopic Dermatitis

Abstract

Corticosteroids are potent anti-inflammatory and anti-allergic agents used in the treatment of various inflammatory diseases, including allergic disease. They are frequently considered the therapy-of-choice for many skin diseases. However, allergic reactions caused by corticosteroids have been reported. Among these, delayed reactions to topical steroids are more common, whereas immediate reactions to systemic steroids are rare. Herein, we report the case of a 32-year-old woman with triamcinolone-induced immediate hypersensitivity reaction, in which the patient had a positive prick test result with triamcinolone. She has had atopic dermatitis (AD) for three years. She had used systemic steroid, cyclosporine, and antihistamine with topical steroids for AD. In clinic, approximately 10 minutes after intralesional injection of triamcinolone, she complained of erythematous patches with slight elevation and itching on the face, trunk, and both hands. After intravenous injection of dexamethasone, her symptoms got worse. After treatment with epinephrine, all symptoms resolved within two hours. We performed an open test and skin prick test. She had a positive result only from the prick test with triamcinolone; all other steroids showed negative results from the open tests. Dermatologists should be aware of the possibility of anaphylaxis or other allergic hypersensitivity in response to corticosteroids.

Anaphylactic shock with methylprednisolone, Kounis syndrome and hypersensitivity to corticosteroids: a clinical paradox

“…Therefore, atopy seems to constitute a disease-substrate that predispose to allergic and anaphylactic reactions. Indeed, a 32-year-old woman suffering from atopic dermatitis [ 12 ], without any previous history of food or drug allergy, no suggestive family history, and no other systemic diseases, developed erythematous patches with slight elevation and itching on the face, trunk, and both hands after 0.7 mL of intralesional triamcinolone solution with concentration 2.5 mg/mL on her dorsum of both hands. Her symptoms worsened with therapeutic intravenous re-administration of dexamethasone and she recovered only after treatment with epinephrine In another recent report, a 52-year-old female patient, without previous history of any illness, developed severe retrosternal pain with electrocardiographic ST depression at II, III, aVF, and V3-V6 leads 15 min following 40 mg/ml of intramuscular triamcinolone acetonide (Kenacort-A Retard IM ampule) administration for rashes and itching of her scalp.…”

“…Therefore, atopy seems to constitute a disease-substrate that predispose to allergic and anaphylactic reactions. Indeed, a 32-year-old woman suffering from atopic dermatitis [ 12 ], without any previous history of food or drug allergy, no suggestive family history, and no other systemic diseases, developed erythematous patches with slight elevation and itching on the face, trunk, and both hands after 0.7 mL of intralesional triamcinolone solution with concentration 2.5 mg/mL on her dorsum of both hands. Her symptoms worsened with therapeutic intravenous re-administration of dexamethasone and she recovered only after treatment with epinephrine…”

Clinical manifestations of Type 1 allergic reactions

“…Bazı yazarlar, daha sonra Coombs ve Gell sınıflandırmalarında değişiklikler /ilave kategoriler önermişlerdir. [1,2] Tip I Aşırı Duyarlılık: Atopik / Anafilaktik tip duyarlılık olarak da adlandırılır. Alerjen olarak adlandırılan belirli bir antijene tekrar maruz kalınmasıyla tetiklenen alerjik bir reaksiyondur.…”

“…Tip I aşırı duyarlılık/Atopik veya anafilaktik tip alerjiler, Ig E aracılı acil hipersensitivite reaksiyonlarıdır. Bu patolojik mekanizmalar sonucunda karşılaştığımız klinik tablolar: [1][2][3] İlaç alerjileri: Advers ilaç reaksiyonları; Tip A ve Tip B olmak üzere ikiye ayılır. Tip A reaksiyonları %85-90 oranında görülür, genellikle doza bağımlı, bir ilacın bilinen farmakolojik özelliklerinden tahmin edilebilir özelliktedir.…”