Systemic corticosteroid hypersensitivity in children

We describe 5 cases of immediate-type reactions to systemic corticosteroids observed during the last 2 decades in boys aged 2, 4, 8, 9, and 10 years. Symptoms ranged from generalized urticaria and angioedema to anaphylactic shock immediately after administration. Oral betamethasone was implicated in 2 cases, oral prednisolone in 2 cases, and intravenous prednisolone in 1 case. The parents of patient 5 refused the skin tests. The remaining patients underwent skin prick tests with the following undiluted corticosteroids: parenteral prednisolone, oral prednisolone, parenteral methylprednisolone, parenteral dexamethasone, parenteral hydrocortisone, and oral betamethasone. If the results were negative, intradermal tests were performed with the same drugs at increasing concentrations. Skin test results were positive for all suspect corticosteroids, thus indicating an immunoglobulin E-mediated mechanism. Two patients had positive skin test results to other corticosteroids, suggesting cross-reactivity. An oral challenge test was performed with deflazacort in 4 cases and with betamethasone in 1 case; the results were negative.