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Immediate and Delayed Hypersensitivity Reactions to Corticosteroids: Evaluation and Management
Iris M Otani1, Aleena Banerji2
1Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA. iotani@mgh.harvard.edu.
Current Allergy and Asthma Reports
|February 10, 2016
Summary
Corticosteroids can cause rare allergic reactions like immediate hypersensitivity and delayed contact dermatitis. Diagnosis involves skin testing and graded challenges to identify culprits and alternative treatments.
Area of Science:
- Immunology
- Dermatology
- Allergy
Background:
- Corticosteroids are widely used anti-inflammatory drugs for allergic conditions.
- While endocrine and GI side effects are known, hypersensitivity reactions are under-recognized.
- Reactions can be to the corticosteroid itself or its preparation's additives/vehicles.
Purpose of the Study:
- To review the clinical presentation, evaluation, and management of hypersensitivity reactions to corticosteroids.
- To highlight the under-recognized immediate and delayed reactions.
- To discuss diagnostic methods and cross-reactivity patterns.
Main Methods:
- Review of current understanding of corticosteroid hypersensitivity.
- Discussion of diagnostic tools: skin testing, oral graded challenge, and patch testing.
- Analysis of cross-reactivity patterns in delayed contact dermatitis.
Main Results:
- Immediate hypersensitivity and delayed contact dermatitis are under-recognized side effects of corticosteroids.
- Diagnostic approaches include skin testing, oral graded challenge for immediate reactions, and patch testing for delayed reactions.
- Cross-reactivity patterns are observed in delayed contact dermatitis based on corticosteroid structure, but not in immediate hypersensitivity.
Conclusions:
- Hypersensitivity reactions to corticosteroids, though rare, require recognition and proper diagnostic evaluation.
- Skin testing and graded challenges are crucial for identifying causative agents and alternative corticosteroids.
- Understanding structural cross-reactivity is important for managing delayed hypersensitivity contact dermatitis.
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