Steroid Allergy: Clinical Features and the Importance of Excipient Testing in a Diagnostic Algorithm

Li, Philip H.; Wagner, Annette; Thomas, Iason; Watts, Troy; Rutkowski, Ryszard; Rutkowski, Krzysztof

doi:10.1016/j.jaip.2018.01.007

Cited by 39 publications

(42 citation statements)

References 18 publications

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“…In most subjects with IHRs, it is possible to identify the culprit and safe alternative GCs by performing immediate‐reading STs 178‐185 . In the aforementioned review, 74.1% of 112 STs carried out with GCs suspected of being responsible for reactions were positive 181 .…”

Section: Anti‐cytokine/anti‐inflammatory Drugs Used For Mas/cytokine mentioning

confidence: 99%

“…Immediate hypersensitivity reactions to excipients or preservatives in GC preparations, such as lactose, carboxymethylcellulose, polyethylene glycol, and hexylene glycol, have also been reported 181,185 . Therefore, testing should be performed with a preservative free GC, in addition to preservative testing per se if needed 185 (Table 3). A study proposed a comprehensive diagnostic algorithm to evaluate hypersensitivity reactions to GCs, as well as to their components and preservatives 185 .…”

Section: Anti‐cytokine/anti‐inflammatory Drugs Used For Mas/cytokine mentioning

confidence: 99%

“…Therefore, testing should be performed with a preservative free GC, in addition to preservative testing per se if needed 185 (Table 3). A study proposed a comprehensive diagnostic algorithm to evaluate hypersensitivity reactions to GCs, as well as to their components and preservatives 185 . This algorithm included STs with Carmellose ® eye drops in subjects who had reacted to carboxymethylcellulose‐containing GCs and with cow's milk proteins in those who had reacted to lactose‐containing GCs.…”

Section: Anti‐cytokine/anti‐inflammatory Drugs Used For Mas/cytokine mentioning

confidence: 99%

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Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

Gelincik

Brockow

Çelik

et al. 2020

Allergy

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Coronavirus disease 2019 (COVID‐19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID‐19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off‐label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings together all the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off‐label drugs and highlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactions in the course of the disease.

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Section: Anti‐cytokine/anti‐inflammatory Drugs Used For Mas/cytokine mentioning

confidence: 99%

Section: Anti‐cytokine/anti‐inflammatory Drugs Used For Mas/cytokine mentioning

confidence: 99%

Section: Anti‐cytokine/anti‐inflammatory Drugs Used For Mas/cytokine mentioning

confidence: 99%

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Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

Gelincik

Brockow

Çelik

et al. 2020

Allergy

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“…Systemic corticosteroid allergy frequently manifests as type I hypersensitivity reactions [4]. The presence of respiratory symptoms is more indicative of true steroid allergy [5]. Risk factors for corticosteroid allergy are aspirinsensitive patients with asthma and renal transplant [3,6].…”

Section: Introductionmentioning

confidence: 99%

Multiple corticosteroids allergy in a patient with asthma: a case report

et al. 2020

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Background: Allergy towards systemic corticosteroid is rare. This case report discusses the investigations to confirm diagnosis and alternative treatments. Case presentation: A 51-year-old asthmatic woman developed severe anaphylactic reaction following administration of systemic hydrocortisone. Skin prick, intradermal, and intravenous provocation tests confirmed allergy to triamcinolone, hydrocortisone, and dexamethasone. Skin prick tests (SPTs) were negative to all the aforementioned drugs. Intradermal test (IDT) with triamcinolone 1:10 concentration resulted in a 2-mm wheal associated with rhonchi. IDT with hydrocortisone 1:10 concentration showed an 8-mm wheal with rhonchi. IDTs to dexamethasone and carboxymethylcellulose were negative. Generalized rhonchi were observed with intravenous dexamethasone full concentration challenge. Conclusions: Corticosteroid allergy should be suspected in asthma patients with worsening bronchospasm after its administration. Due to its rarity, such diagnosis can easily be missed, resulting in increased morbidity and mortality in patients.

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“…In our experience, we have not identified any consistent patterns of cross-reactivity in immediate hypersensitivity. When searching for suitable alternatives, we would instead advocate an individualized and comprehensive approach based on our previously published algorithm [6].…”

mentioning

confidence: 99%