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Immediate-type hypersensitivity to succinylated corticosteroids
Annett Isabel Walker1, Helen-Caroline Räwer, Wolfgang Sieber
1Klinik und Poliklinik für Dermatologie und Allergologie, AllergieZENTRUM, Ludwig-Maximilians-Universität, München, Deutschland. annett.walker@med.uni-muenchen.de
International Archives of Allergy and Immunology
|November 27, 2010
Summary
Severe immediate hypersensitivity reactions can occur with corticosteroid succinate esters. These reactions are linked to the succinate component, not the corticosteroid itself, highlighting the need for careful drug selection.
Area of Science:
- Immunology
- Pharmacology
- Allergy and Clinical Immunology
Background:
- Systemic corticosteroids are widely used, but immediate-type hypersensitivity reactions are uncommon.
- Previous reports of corticosteroid-induced hypersensitivity are rare.
Observation:
- Two male patients experienced severe immediate hypersensitivity reactions after receiving corticosteroid succinate esters.
- Diagnostic evaluations included skin tests, basophil activation tests, and challenge tests.
Findings:
- Both patients showed positive immediate-type skin reactions to methylprednisolone sodium succinate and prednisolone sodium succinate.
- Nonsuccinylated corticosteroids did not elicit reactions. Basophil activation markers (CD63) increased with succinylated corticosteroids in vitro.
- Challenge tests confirmed severe reactions to succinylated corticosteroids, while nonsuccinylated forms were tolerated.
Implications:
- Clinicians should be aware of rare but severe immediate hypersensitivity reactions to corticosteroid succinate esters.
- The succinate moiety is implicated as the causative agent in these reactions.
- Identifying the specific causative agent is crucial for managing corticosteroid allergies and selecting safe alternatives.
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