001542 - Immediate Hypersensitivity to Systemic Corticosteroids: Two Case Reports with Safe Alternative Identification
Case report
BACKGROUND
Immediate hypersensitivity reactions to systemic corticosteroids are uncommon but may lead to severe, life-threatening anaphylaxis. Cross-reactivity among corticosteroids in immediate reactions is not fully predictable, complicating clinical management. We report two cases of confirmed corticosteroid allergy with different diagnostic patterns, highlighting the importance of comprehensive allergy work-up to identify safe alternatives.
CASES REPORTS
Case 1:A 44-year-old woman with chronic colitis. She had an ICU-treated anaphylactic reaction to injectable dexamethasone, immediately after the 11th dose of intraarticular treatment. She was referred to our Allergology Department for allergy assessment to determine safe therapeutic options.
Case 2:A 57-year-old man with systemic mastocytosis and severe asthma. He developed reactions with different corticosteroids: topic Prednicarbate (local erythema and pruritus), inhaled Budesonide/formoterol (chest pain), nasal Budesonide (hives, erythema and pruritus in trunk). After checking a good tolerance to Dexamethasone he had hand angioedema with inhaled beclomethasone.
In both cases skin tests to corticosteroids (CE) were done, also oral drug provocation test.
RESULTS
Case 1:Skin prick tests and intradermal tests to corticosteroids were negative for Methylprednisolone, Prednisone and Deflazacort. Oral drug provocation test with prednisone was positive. Deflazacort was tolerated and identified as a safe alternative. (Table)
Case 2:Skin prick tests, intradermal tests and DPT were negative for Triamcinolone , Dexamethasone, Fluticasone, being identified as safe alternatives. With Beclometasone we obtained negative skin prick tests and intradermal tests, but positive DPT. (Table)
CONCLUSION:
Immediate hypersensitivity to systemic corticosteroids can present with severe anaphylaxis and heterogeneous diagnostic patterns.
Structural classification (Baeck et al) can predict cross-reactivity in immediate reactions.
A comprehensive allergy work-up, including drug provocation tests when appropriate, is crucial to confirm diagnosis and to identify safe alternative corticosteroids for future treatment.
