Chronic urticaria associated with intra-articular methylprednisolone

Reports of allergic reactions following treatment with systemic corticosteroids are rare, despite their widespread use. A 47-year-old man developed widespread urticaria, resistant to antihistamines, coinciding with injections of local anaesthetic and methylprednisolone for cervical spondylosis. He underwent immediate and delayed hypersensitivity tests. Intradermal tests showed immediate-type sensitivity to methylprednisolone and hydrocortisone. Patch tests were positive to 21 of 26 corticosteroids tested. A diagnosis of both an immediate and a delayed-type hypersensitivity to corticosteroids was made. With avoidance of all corticosteroids he has been free from urticarial rash for 9 months and has been able to stop all medication.