pulmicort and tixocortol-pivalate

An alternative view of corticosteroid cross-reactivity is proposed, based on 2 immune recognition sites on the corticosteroid molecule, 1 influenced by C 6/9 substitution and 1 by C 16/17 substitution. A case report is adduced in support of such a hypothesis.

Topics: Administration, Topical; Adult; Allergens; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Dermatologic Agents; Female; Humans; Hydrocortisone; Molecular Structure

Topics: Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Clinical Trials as Topic; Colitis, Ulcerative; Crohn Disease; Fluticasone; Humans; Hydrocortisone; Prednisolone; Pregnenediones

Topics: Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Hypersensitivity; Humans; Hydrocortisone; Patch Tests; Skin

Topics: Administration, Topical; Adrenal Cortex Hormones; Budesonide; Drug Eruptions; Female; Humans; Hydrocortisone; Hypersensitivity, Delayed; Injections, Intra-Articular; Middle Aged

Topics: Adenoids; Anti-Allergic Agents; Budesonide; Child, Preschool; Dermatitis, Allergic Contact; Diagnosis, Differential; Erythema Multiforme; Face; Glucocorticoids; Humans; Hydrocortisone; Hypertrophy; Male; Nebulizers and Vaporizers; Skin Tests

Delayed allergic hypersensitivity reactions have classically been described as type IV reactions, which are caused by T cells; however, the respective roles of CD4(+) and CD8(+) cells are yet to be defined. A central role for CD8(+) cytotoxic T cells as effector cells has been suggested.. To determine the type of T cell involved in corticosteroid allergy.. We analysed the kinetics of T cell recruitment and the cytokine production profile in positive patch tests of 27 corticosteroid-sensitized patients, as compared with control sites and control subjects. Skin biopsies, collected at 8, 24 and 48 hr following drug application, were embedded in paraffin for histological and immunohistological staining, and, in some cases, also deep-frozen for gene expression analyses.. CD3(+) T cells were rapidly recruited in concert with the positivity of the patch test sites. High levels of interleukin (IL)-4, IL-5 and, to a lesser extent, interferon-γ suggested that both Th2 and Th1 cytokines were implicated. IL-4 was also produced by γδ T cell receptor (TCR) lymphocytes.. This study showed that, in allergic contact dermatitis caused by corticosteroids, the inflammatory infiltrate is composed of CD3(+) T cells with a predominant Th2 cytokine profile, among which IL-4 is also produced by γδ TCR lymphocytes.

Topics: Adult; Aged; Biomarkers; Biopsy; Budesonide; Case-Control Studies; CD3 Complex; Dermatitis, Allergic Contact; Drug Eruptions; Female; Flow Cytometry; Glucocorticoids; Humans; Hydrocortisone; Immunohistochemistry; Interferon-gamma; Interleukin-4; Interleukin-5; Linear Models; Logistic Models; Male; Middle Aged; Patch Tests; Receptors, Antigen, T-Cell, gamma-delta; Reverse Transcriptase Polymerase Chain Reaction; Skin; T-Lymphocytes

In order to map the frequency of contact hypersensitivity (CH) to epoxy resin, methyldibromoglutaronitrile (MDBGN), tixocortol pivalate (TP) and budesonide patch tests were carried out.. The tests were performed in 1448 patients. Most patients belong to the allergic and irritative contact dermatitis groups. The tests were administered with the allergens epoxy resin 1%, MDBGN 0.3%, TP 1% and budesonide 0.1%, applied on the back. Reactions were evaluated at 40 min, on day 2 (D2), day 3 (D3) and day 4 (D4). In the patients of the Dept. of Dermatology, Venerology and Dermatooncology of Semmelweis University (patients number =1073) reactions were evaluated on day 7 as well.. Epoxy resin elicited immediate reactions in 1 patient at 40 min. Further evaluations showed no difference on D3, D4 and D7 with a frequency of CH of 1.03%. Patch testing for MDBGN did not provoke immediate reactions, evaluations showed an increasing hypersensitivity rate (D2: 0.93%; D7:1.77%). Patch tests with TP yielded no immediate reactions, the frequency of CH increased from 0.47% (D2) to 2.01% (D7). No immediate reactions were observed by budesonide; an increase was seen in frequency of CH (D2:0.93% to D7:3.84%). CH to the studied allergens was observed mostly in allergic contact dermatitis group, to budesonide in irritative contact dermatitis and in atopic dermatitis groups as well.. The data of the present study are the first results about this four allergens in Hungary and to our knowledge from our region as well.

Topics: Allergens; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Contact; Dermatitis, Irritant; Epoxy Resins; Humans; Hungary; Hydrocortisone; Hypersensitivity, Immediate; Nitriles; Patch Tests; Preservatives, Pharmaceutical; Urticaria

Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability.. To estimate the prevalence of tixocortol-21-pivalate, budesonide and hydrocortisone-17-butyrate allergy in a Danish patch test population and characterize individuals with corticosteroid allergy.. Three thousand five hundred and ninety-four patients were patch tested with tixocortol-21-pivalate, budesonide, and hydrocortisone-17-butyrate. Characterization was performed according to the MOAHLFA index and duration of disease.. Two per cent had a steroid allergy: 0.8% had a tixocortol-21-pivalate allergy, 1% a budesonide allergy, and 1% a hydrocortisone-17-butyrate allergy. Tixocortol-21-pivalate and budesonide allergy were associated with atopic dermatitis in crude analyses, but only tixocortol-21-pivalate allergy and atopic dermatitis remained associated in adjusted analyses. Leg dermatitis was uniquely associated with tixocortol-21-pivalate allergy. Hydrocortisone-17-butyrate allergy was associated with duration of disease in both crude and adjusted analyses.. Chronic dermatoses (atopic dermatitis and leg dermatitis) were identified as risk factors for group A corticosteroid allergy, probably because of more pronounced exposure to group A steroids resulting from ease of access that is exploited by patients with a chronic dermatosis. The duration of disease rather than the dermatosis itself seemed to be important for group B and D2 corticosteroid allergy.

Topics: Adult; Budesonide; Chronic Disease; Denmark; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Occupational; Dermatologic Agents; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hydrocortisone; Leg Dermatoses; Male; Middle Aged; Patch Tests; Prevalence; Risk Factors

The reported prevalence of allergic contact dermatitis from topical corticosteroids in clinical populations, in the period 1993-2002, varied from 0.55 to 5.98%. This study is a retrospective analysis of 1153 individuals undergoing routine patch testing in an Occupational Dermatology Clinic in Melbourne, Australia. We report a rate of 0.52% for positive patch test reactions to 5 corticosteroids. Corticosteroids tested were betamethasone-17-valerate, budesonide, Diprosone cream (betamethasone diproprionate 0.05%) (Essex-Pharma, a division of Schering-Plough Pty Ltd, Sydney, Australia), tixocortol-21-pivalate and triamcinolone acetonide. Population characteristics were described using the MOAHL (M = percentage of males tested; O = occupational; A = atopics; H = patients with hand eczema; L = patients with leg ulcers or stasis eczema) index. Prescribing patterns, rate of referral and rate of relevant positive patch test reactions were characterized for the region. These results were compared to the rates of corticosteroid allergy and patch testing methodologies from published international studies. It was noted that many high-sensitization potential corticosteroids were not available in our region. Although a low percentage of leg ulcers and stasis dermatitis may be associated with a lower rate of corticosteroid allergy, this association may be confounded by regional factors such as prescribing habits and the local availability of corticosteroids. We conclude that the low rate of topical corticosteroid contact allergy reported by our clinic is associated with regional availability and prescribing practices and the scarcity of stasis dermatitis and leg ulcers in our clinic population.

Topics: Administration, Topical; Adult; Australia; Betamethasone; Betamethasone Valerate; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Occupational; Drug Utilization; Female; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Practice Patterns, Physicians'; Prevalence; Retrospective Studies; Triamcinolone Acetonide

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Chi-Square Distribution; Dermatitis, Allergic Contact; Humans; Hydrocortisone; Patch Tests; United Kingdom

Topics: Administration, Topical; Allergens; Anti-Inflammatory Agents; Austria; Budesonide; Dermatitis, Allergic Contact; Germany; Humans; Hydrocortisone; Patch Tests

This study investigated whether a corticosteroid mix containing tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate could detect contact allergy to corticosteroids. 2 corticosteroid mixes, 1 with a high (mix I) and 1 with a low (mix II) concentration and the 3 individual constituents, each at 2 concentrations, were inserted into the standard series of 16 participating clinics. Tests were read on day (D) 3 or 4. 5432 patients were tested, and 110 (2.0%) had positive reactions to at least 1 of the 8 test preparations. Of the 8 preparations, mix I identified most allergic patients, followed by mix II, budesonide 0.10%, budesonide 0.002%, and tixocortol pivalate, both concentrations (1.0 and 0.10%) tracing the same number. With the mixes, 53.2-59.6% of tixocortol pivalate allergy was missed. 47 patients were allergic to either concentration of tixocortol pivalate, 25% of these only to 1.0% and another 25% only to 0.10%. Testing with mix I and tixocortol pivalate 0.10% picked up 98/110, testing with tixocortol pivalate 1.0% and 0.10% and budesonide 0.10% picked up 105/110. 3379 patients were read on both D3 or D4 as well as on D7. Without a late reading (D7), up to 30% of contact allergy to corticosteroid markers was missed.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Combinations; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Male; Patch Tests

This study investigated the stability of tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate (Hc-17-B) when present in a mix with petrolatum and when the corticosteroids were kept separately in petrolatum. The concentrations chosen for the corticosteroids were the same as those used in a study within the European Environmental Contact Dermatitis Research Group (EECDRG), in which 2 corticosteroid mixes (1 with a high concentration and 1 with a low concentration) and the 3 individual constituents, each at 2 concentrations, were patch tested. Ethanolic solutions of each corticosteroid, as well as 2 mixtures of these 3 corticosteroids, were also made up at corresponding concentrations. The preparations were kept at room temperature, refrigerated, and deep frozen, and repeatedly for 1 year, investigations to check stability by high performance liquid chromatography were carried out. A decrease of < or =20% of the initial value at time 0 was used as the threshold for stability. The petrolatum preparations and the ethanolic solutions of budesonide and tixocortol pivalate were stable for at least the whole investigative period, irrespective of storage conditions, while Hc-17-B 1.0% in ethanol kept deep frozen was stable at least during the same period. The latter corticosteroid when kept at room temperature was stable for 3 months only.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Stability; Hydrocortisone; Patch Tests

Topics: Administration, Topical; Allergens; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Europe; Humans; Hydrocortisone; Patch Tests; Practice Guidelines as Topic; Reference Standards

The potency of budesonide, beclomethasone dipropionate (BDP), dexamethasone, hydrocortisone and tixocortol pivalate as inhibitors of interleukin-5 (IL-5) and interferon-gamma (IFNgamma) release from human bronchoalveolar lavage cells in vitro were compared.. BAL leukocytes were obtained from patients undergoing bronchoscopy for diagnostic purposes. BAL leukocytes were activated with PHA (10 microg/ml) and PMA (10 ng/ml) and cultured for 48 h in the presence or absence of glucocorticoids. Culture supernatants were assayed for cytokines by ELISA.. Budesonide (10(-9) to 10(-7) M) and BDP (10(-8) to 10(-6) M) were the most potent glucocorticoids tested. Dexamethasone (10(-7) to 10(-5) M) was less potent, and the maximum inhibitory effect of dexamethasone was less than that produced by than budesonide or BDP. Tixocortol pivalate (10(-6) to 3 x 10(-5) M) caused a concentration-related inhibition of IL-5 release but only the highest concentration tested inhibited the release of IFNgamma. Hydrocortisone (10(-4) M) inhibited IL-5 and IFNgamma release.. We conclude that, unlike the other glucocorticoids tested, tixocortol pivalate appeared to be a selective inhibitor of IL-5 release. Possible mechanisms for this selectivity are discussed.

Topics: Anti-Inflammatory Agents; Beclomethasone; Bronchoalveolar Lavage; Budesonide; Cells, Cultured; Cytokines; Dexamethasone; Drug Interactions; Glucocorticoids; Humans; Hydrocortisone; In Vitro Techniques; Leukocytes; Phytohemagglutinins; Tetradecanoylphorbol Acetate

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Asthma; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Humans; Hydrocortisone; Patch Tests; Rhinitis

Tixocortol pivalate is an established marker to topical corticosteroid allergy. The prevalence of tixocortol pivalate hypersensitivity is well established in Europe, where exposure to this corticosteroid as a therapeutic agent varies. In the United States, tixocortol pivalate is not commercially available and the prevalence of hypersensitivity to it is unknown.. We investigated the prevalence of tixocortol pivalate hypersensitivity in our patch-tested population. We further characterized these patients by clinical background, other contact allergens, and the reactivity to other corticosteroids.. Tixocortol pivalate has been incorporated in our standard 1-52 patch test series since November 1992. We reviewed the histories and patch test results in all patients tested with the standard 1-52 series from November 1992 to December 1996.. Of 1536 patch-tested patients, 45 had hypersensitivity to tixocortol pivalate. Dermatitis involving the face was the most common (14 patients). Of the 45 patients, 40 had another allergen identified on patch testing. Eighteen patients underwent further patch testing to an extended corticosteroid panel, and 14 had sensitivity to another steroid agent.. The 2.9% prevalence of tixocortol pivalate hypersensitivity in our patch test population is within the range reported in Europe. Patients with tixocortol pivalate hypersensitivity tend to have other contact allergens on patch testing. Predisposing factors to tixocortol pivalate hypersensitivity include facial dermatitis and sensitivity to other contact allergens.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Allergens; Anti-Allergic Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Europe; Facial Dermatoses; Female; Humans; Hydrocortisone; Male; Middle Aged; Minnesota; Neomycin; Patch Tests; Prevalence; Risk Factors; Triamcinolone

The correct concentration and vehicle for patch testing with corticosteroids is in many instances not known. The results of this study suggest that 1% in ethanol should be the initial choice, unless it can be shown that petrolatum as a vehicle is as sensitive (tixocortol pivalate and budesonide). We could find no evidence for the anti-inflammatory effects of corticosteroids inhibiting the patch test at higher concentrations. Using ethanol as the vehicle resulted in reactions developing at earlier time points than with petrolatum.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dermatologic Agents; Drug Eruptions; Ethanol; Humans; Hydrocortisone; Patch Tests; Petrolatum; Pharmaceutical Vehicles; Pregnenediones

Mometasone furoate is a new corticosteroid, synthesized to have an improved ratio of anti-inflammatory potential to adverse effects. The guinea pig maximization test was used to determine the sensitizing capacity of mometasone furoate, and also to investigate cross-reaction patterns in animals sensitized to tixocortol pivalate and budesonide, respectively. Tixocortol pivalate was shown to be a sensitizer in the guinea pig, but cross-reactions to other tested corticosteroids were not observed. Furthermore, no sensitizing capacity could be demonstrated for budesonide or mometasone furoate.

Topics: Administration, Cutaneous; Administration, Topical; Animals; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Female; Glucocorticoids; Guinea Pigs; Hydrocortisone; Immunization; Injections, Intradermal; Mometasone Furoate; Patch Tests; Prednisolone; Pregnadienediols; Pregnenediones; Time Factors; Triamcinolone Acetonide

Despite the widespread use of corticosteroids on the mucous membranes of the nose, eye and bronchial tree, mucosal contact sensitivity has apparently been uncommon. However, since the introduction of new corticosteroids such as tixocortol pivalate and budesonide, mucosal contact sensitivity, particularly that affecting the nasal mucosa, has increasingly been reported. Contact allergy on other mucosal surfaces and in the bronchial tree is very rare. We report three women who had contact allergy to tixocortol pivalate or budesonide in nasal sprays, and one woman who had an allergic contact stomatitis from tixocortol pivalate in oral lozenges.

Topics: Administration, Intranasal; Administration, Oral; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Drug Eruptions; Female; Humans; Hydrocortisone; Hypersensitivity, Delayed; Pregnenediones; Stomatitis

Topical corticosteroids are increasingly recognized as relatively common contact sensitizers. Between July 1988 and December 1991 2687 patients undergoing routine patch testing were also tested with tixocortol pivalate (TP). Over the same time period 528 patients were selected for testing with a series of 18 steroids. One-hundred and thirty-one cases (4.9%) of corticosteroid hypersensitivity were detected and 119 (90.8%) of these cases were positive to TP. Thirty-seven patients reacted to one or more steroids in the steroid series, the most frequent sensitizers being hydrocortisone, budesonide (3.6%) and hydrocortisone 17-butyrate (2.5%). Of these 37 cases, 20 (54%) reacted to more than one steroid simultaneously, but the patterns of cross-reaction were not consistent with previously suggested groupings. Screening for steroid allergy should be performed as part of standard patch testing. The value of TP as a marker of corticosteroid hypersensitivity is reinforced by this study, but no satisfactory marker was found for the 9.2% of cases not detected by TP. There remains a need for further markers of corticosteroid hypersensitivity. A prevalence of 4.9% of corticosteroid allergy amongst our patients suggests that the frequency of this finding is generally underestimated.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Budesonide; Child; Dermatitis, Allergic Contact; Female; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Pregnenediones; Prevalence

Topics: Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Betamethasone Valerate; Budesonide; Colitis, Ulcerative; Fluticasone; Glucocorticoids; Humans; Hydrocortisone; Prednisolone; Pregnenediones