Prednis-OH NO! – A Case of Anaphylaxis Induced by Prednisone

Abstract

Background: Anaphylaxis is a potentially life-threatening condition caused by the sudden release of inflammatory mediators into the systemic circulation. Among this condition’s etiologies, corticosteroid-induced anaphylaxis, despite being uncommon, should receive due consideration given the frequency of steroid use in various settings. Any patient that presents with shortness of breath, wheezing, hypotension, urticaria, or other characteristic signs of anaphylaxis following the administration of steroids should be promptly evaluated. Because of the potentially fatal nature of anaphylaxis, clinicians must be familiar with the presentation, diagnosis, and management of the reaction. Case Report: The primary objective of this case report is to discuss an example of such a reaction in a 21-year-old female with a past medical history of anxiety, depression, and alcoholism who presented with anaphylaxis following prednisone use, as well as the proposed pathophysiology and management thereafter. She was managed with intravenous epinephrine and diphenhydramine with complete resolution of her symptoms. She was subsequently discharged with an EpiPen, cetirizine, and advised to establish care with an allergist for follow up and additional allergy testing. To complete this case report, we performed a review of current primary literature on the subject. Conclusions: Though uncertain, many potential mechanisms of sensitization to corticosteroids were identified, including haptenization, preservatives, excipients, and conjugated esters. Various means exist to aid in diagnosis, such as skin testing, immunoCAP assays, lymphocyte transformation tests, basophil activation tests, and graded drug challenges, though these tests are associated with a high false negative rate. Accurate identification of the causative agent is crucial in facilitating avoidance or rapid desensitization prior to future corticosteroid use.