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[Intolerance to hydrocortisone in two patients with bronchial asthma]
E Bogacka1, J Małolepszy, R Suchnicka
1Katedry i Kliniki Chorób Wewnetrznych i Alergologii we Wrocławiu.
Pneumonologia I Alergologia Polska
|January 1, 1994
Summary
Patients with asthma intolerant to hydrocortisone experienced reduced lung function (FEV1) after hydrocortisone challenges, suggesting a nonallergic reaction. Alternative corticosteroids like prednisolone are recommended for treating hydrocortisone-intolerant asthma patients.
Area of Science:
- Pulmonology
- Clinical Immunology
- Pharmacology
Background:
- Hydrocortisone intolerance presents a challenge in managing asthma, particularly in patients with aspirin sensitivity.
- Investigating the mechanism and alternative treatments for hydrocortisone intolerance in asthma is crucial for patient care.
Observation:
- Two asthma patients, one with nonatopic aspirin-sensitive asthma and another with atopic asthma, exhibited intolerance to hydrocortisone.
- Provocation tests revealed a significant decrease in Forced Expiratory Volume in 1 second (FEV1) following intravenous, inhaled, and oral hydrocortisone exposure, but not with its solvent.
- Intradermal skin testing with hydrocortisone and its solvent yielded negative results, indicating a likely nonallergic basis for the intolerance.
Findings:
- The observed hydrocortisone intolerance in these asthma patients appears to be a nonallergic phenomenon.
- Patients tolerated alternative corticosteroids, including intravenous prednisolone and oral prednisone, prednisolone, and betamethasone, without adverse reactions.
Implications:
- These findings suggest that hydrocortisone may not be the optimal choice for patients with asthma exhibiting hydrocortisone intolerance.
- The successful tolerance of alternative corticosteroids indicates a viable therapeutic strategy for managing such patients.
- Replacing intravenous hydrocortisone with prednisolone or other suitable corticosteroids is recommended for asthma patients with documented hydrocortisone intolerance.