[Skin allergy to hydrocortisone hemisuccinate in a patient with asthma]

Corticosteroids are the basis of treatment of asthma; they interrupt the development of inflammation. However, corticosteroids can also be at the origin of severe allergical reactions.

A 40 Year-old woman, during hospitalisation for severe acute asthma, presented with an allergy to hydrocortisone hemisuccinate (HCHS) in the form of generalised pruritus with, on examination, cutaneous mucosal lesions in the form of purpura and ecchymoses on the abdomen and the upper and lower limbs. The substitution of HCHS led to the return to normal.

Allergic reactions to corticosteroids, generally paradoxical, were for many Years ignored and their existence was controversial. They were usually secondary to the administration of injectable substances containing hydrocortisone hemisuccinate or methylprednisolone. Their physiopathology remains a mystery. Their management requires the immediate and permanent withdrawal of the product implied, antihistamine and adrenalin in the case of shock and symptomatic treatment.