(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Drug-Hypersensitivity

Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play a central role in the treatment of bronchial asthma. Fluticasone exhibits excellent clinical effectiveness; however, oral adverse effects can occur.. To compare the frequency of oral candidiasis in asthmatic patients treated with fluticasone and beclomethasone, to evaluate the effect of gargling with amphotericin B, and to measure the inhalation flow rate on candidiasis.. The study consisted of 143 asthmatic patients who were treated with inhaled steroids, 11 asthmatic patients not treated with inhaled steroids, and 86 healthy volunteers. Quantitative fungal culture was performed by aseptically obtaining a retropharyngeal wall swab from these patients. Patients with positive results were treated with gargling using a 1:50 dilution amphotericin B solution. In asthmatic patients treated with fluticasone, the inhalation flow rate was measured using an inspiratory flow meter.. The amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not. It was also significantly greater in patients with oral symptoms than asymptomatic patients and significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Although the presence of Candida did not correlate with the inhaled dose of beclomethasone, it did increase with the dose of fluticasone. Gargling with amphotericin B was effective in most asthmatic patients with candidiasis. Candidiasis was not due to inappropriate flow rates during inhalation of steroids.. Fungal culture of a retropharyngeal wall swab may be useful for predicting the risk of developing oral candidiasis in asthmatic patients treated with inhaled steroids. The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:50 dilution of amphotericin B is effective in treating oral candidiasis of asthmatic patients treated with inhaled steroids.

Topics: Administration, Inhalation; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Androstadienes; Anti-Inflammatory Agents; Antifungal Agents; Asthma; Beclomethasone; Candidiasis, Oral; Dose-Response Relationship, Drug; Drug Hypersensitivity; Female; Fluticasone; Glucocorticoids; Humans; Japan; Male; Middle Aged; Regression Analysis; Statistics as Topic; Treatment Failure

In dermatological practice, allergy to topical corticosteroids used to treat eczema is a recognized and common event. The typical presentation is of an eczema which fails to improve or deteriorates with treatment. Topical corticosteroids are also used to treat mucosal disease. This study assesses allergy to inhaled corticosteroids in asthmatics. In the patient group selected, there was no evidence of relevant corticosteroid allergy.

Topics: Administration, Inhalation; Administration, Topical; Adult; Aged; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Budesonide; Drug Hypersensitivity; Female; Glucocorticoids; Humans; Immunoglobulin G; Intradermal Tests; Male; Methylprednisolone; Middle Aged; Pregnenediones

Topics: Adolescent; Adult; Allergens; Animals; Asthma; Beclomethasone; Child; Clinical Trials as Topic; Cromolyn Sodium; Desensitization, Immunologic; Drug Hypersensitivity; Female; Histamine Release; Humans; Male; Middle Aged; Physical Exertion; Rats; Rhinitis, Allergic, Seasonal; Stimulation, Chemical

Allergy does not modify the symptoms of nasal polyposis, either initially or after a 1-year medical treatment.. To assess the role of allergy in the symptoms and treatment of patients presenting with the diagnosis of nasal polyposis.. Two simultaneous studies were carried out. In the first study, 180 consecutive patients with nasal polyposis (60% males, mean age = 48.4 years) were analyzed to detect whether the severity of their symptoms correlated with the presence of positive allergic tests. In the second study, 74 consecutive patients (57.5% males, mean age = 48.3 years) were analyzed to detect whether the results of a 1-year medical treatment of nasal polyposis were influenced by the presence of positive allergic tests (Phadiatop). Five nasal criteria were scored: nasal obstruction, anterior and posterior rhinorrhea, facial pain, and the loss of sense of smell. The frequency of asthma was evaluated. Treatment of nasal polyposis consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of steroid consumption (prednisolone and beclomethasone) was studied.. In the first study, mean scores of nasal symptoms did not differ between the two groups of patients with and without allergy. The prevalence of asthma (p = 0.03) was higher in the group with than without allergy. In the second study, decrease of all nasal symptoms was not statistically different in the two groups. Cumulative consumption of prednisolone and beclomethasone between baseline and year 1 were similar in the two groups.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Beclomethasone; Bronchial Provocation Tests; Comorbidity; Cross-Sectional Studies; Drug Hypersensitivity; Follow-Up Studies; Forced Expiratory Volume; Humans; Immunoglobulin E; Methacholine Chloride; Nasal Obstruction; Nasal Polyps; Olfaction Disorders; Prednisolone; Prospective Studies; Rhinitis, Allergic, Perennial

Management of nasal polyposis should be primarily medical. Resorting to intranasal ethmoidectomy should not be envisaged before a trial of dual steroid therapy. Nevertheless, no risk factor for steroid insensitivity in patients with nasal polyposis is actually defined. The aim of this study is to evaluate whether the presence of asthma and/or non-specific bronchial hyperresponsiveness (BHR) can be considered a risk factor for steroid insensitivity.. This study focused on the evaluation of a dual modality, topical and systemic, over a follow-up period of 3 years. A total of 55 subjects with and 45 subjects without BHR were treated according to a standardized therapeutic protocol combining short-term oral administration of prednisolone and a daily intranasal spray of beclomethasone.. Over the follow-up period of 3 years, this dual modality proved to be successful in 93.4% of subjects without BHR and without aspirin idiosyncrasy, in 82.2% of subjects with BHR and without aspirin idiosyncrasy and in 60% of subjects with BHR and aspirin idiosyncrasy. The percentage of patients who underwent surgery after the failure of medical treatment was significantly larger in patients with than without BHR (p < 0.05) and in patients with than without aspirin idiosyncrasy (p < 0.02).. The presence of BHR and/or aspirin idiosyncrasy can be considered a major risk factor for steroid insensitivity in patients with nasal polyposis.

Topics: Administration, Oral; Aerosols; Anti-Asthmatic Agents; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents, Hormonal; Aspirin; Asthma; Beclomethasone; Bronchial Hyperreactivity; Bronchial Provocation Tests; Drug Hypersensitivity; Drug Resistance; Ethmoid Sinus; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Middle Aged; Nasal Polyps; Prednisolone; Risk Factors; Tablets; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome

Most studies investigating steroid allergy have been performed with tixocortol pivalate, hydrocortisone butyrate and budesonide. Betnovate and Dermovate are widely prescribed in the U.K. but little is known about the frequency of sensitization to them.. To determine the optimum method to detect contact allergy to betamethasone valerate (BV) and clobetasol propionate (CP).. Seven centres tested consecutive patients attending for investigation of suspected allergic contact dermatitis to these steroids at a range of concentrations in different vehicles.. Of 1562 patients tested, 16 (1%) reacted to either BV or CP. Ten patients (0.7%) reacted to BV and 13 (0.8%) to CP. Two patients of a further centre were included in analysis of dilutions and vehicles. Sixteen of a total of 25 reactions (64%) were identified with a 1% dilution in ethanol.. Consideration should be given to adding BV and CP to a standard allergy series, given that both are frequently used in the treatment of eczema and that most patients sensitized to them are not identified with currently used markers of steroid allergy. If patch tests to BV and CP are initially negative, but an allergy is suspected, the patient should be further investigated. Further studies are required to identify the ideal patch test material.

Topics: Adult; Aged; Aged, 80 and over; Beclomethasone; Clobetasol; Dermatitis, Contact; Drug Hypersensitivity; Ethanol; False Negative Reactions; Female; Glucocorticoids; Humans; Male; Middle Aged; Patch Tests; Predictive Value of Tests; Prevalence

Topics: Administration, Inhalation; Asthma; Beclomethasone; Dermatitis, Allergic Contact; Drug Hypersensitivity; Female; Humans; Middle Aged; Patch Tests

Topics: Administration, Inhalation; Adrenergic beta-Agonists; Albuterol; Allergens; Asthma; Beclomethasone; Drug Hypersensitivity; Glucocorticoids; Humans; Randomized Controlled Trials as Topic; Research Design; Salmeterol Xinafoate

In an attempt to study the pathogenesis of mucosal hypersensitivity in allergic rhinitis, we investigated the suppressive effects of cyclosporin A (CyA) and glucocorticosteroids on ovalbumin (OA)-induced hypersensitivity to topical histamine challenge.. Actively sensitized Dunkin-Hartley guinea pigs.. OA and alum were applied to guinea pigs intraperitoneally 3 times at two-week intervals. After general sensitization, OA inhalation was performed every day for 6 days as topical sensitization. Before inhalation, treatment with CyA (50 mg/kg, p.o.), glucocorticosteroids (beclomethasone propionate (1.0 mg/kg, i.p.), fluticasone propionate (FP, 0.5 mg/kg, i.p.)) or vehicle were performed, and the sensitivity to histamine was measured before and after the inhalation. Moreover, in actively (general and topical) sensitized guinea pigs, FP (0.5 mg/kg, i.p.) was applied every day for 5 days and histamine sensitivity was evaluated before and after the application.. We found that histamine sensitivity was significantly increased by nasal antigen challenge in this guinea pig model, and that the occurrence of histamine hypersensitivity was inhibited by the pretreatment with CyA and glucocorticosteroids. Although multiple administration of FP gradually reduced the histamine hypersensitivity according to the period of administration, it did not significantly alter the histamine hypersensitivity after the occurrence of hypersensitivity.. It is concluded that CyA and glucocorticosteroids suppress antigen-induced histamine hypersensitivity in a guinea pig model of allergic rhinitis.

Topics: Administration, Inhalation; Androstadienes; Animals; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Cyclosporine; Disease Models, Animal; Drug Hypersensitivity; Fluticasone; Glucocorticoids; Guinea Pigs; Histamine; Immunosuppressive Agents; Injections, Intraperitoneal; Male; Ovalbumin; Rhinitis, Allergic, Perennial

We evaluated the effects of corticosteroid pretreatment on the intensity of adverse reactions to aspirin during carefully controlled aspirin challenges in 13 aspirin-sensitive asthmatics. Two studies were performed. First, using a double-blind crossover design, we administered to five patients 75 mg prednisone daily or placebo for two days preceding the challenge. No consistent protection against adverse reactions was achieved. In the second study, a 10-day pretreatment with 15 mg oral prednisolone and topical intrabronchial and intranasal beclomethasone offered total clinical protection against bronchospasm produced by threshold doses of aspirin in five of eight patients. In two others, the bronchospasm provoked was less severe, and only in one patient did its intensity remained unchanged. There was a significant reduction in fall of mean pulmonary function tests following the second aspirin challenge, which was performed after ten days of steroid treatment. Steroids given for ten days also prevented significantly nasal discharge and nasal blockade. When diagnostic challenge tests with aspirin are carried out in asthmatic patients on long-term corticosteroid therapy, there is an increased possibility of false negative results.

Topics: Adult; Aspirin; Asthma; Beclomethasone; Double-Blind Method; Drug Hypersensitivity; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Male; Middle Aged; Peak Expiratory Flow Rate; Prednisolone; Prednisone; Random Allocation

Topics: Aerosols; Asthma; Beclomethasone; Child, Preschool; Drug Hypersensitivity; Humans; Male

Topics: Adult; Aged; Asthma; Beclomethasone; Bronchi; Drug Hypersensitivity; Female; Humans; Male; Middle Aged

Our recent studies of nasal histamine sensitivity in nasal allergy are presented. The sensitivity differed according to the site and size of the nasal mucosa and was correlated with the degree of provocation reaction to antigen. This sensitivity appears to be established in childhood and strongly correlated with the increased sensitivity of histamine receptors as well as the autonomic nervous system dysfunction of the nose.

Topics: Adolescent; Adult; Aged; Airway Resistance; Beclomethasone; Child; Child, Preschool; Cromolyn Sodium; Drug Hypersensitivity; Histamine; Histamine H1 Antagonists; Humans; Middle Aged; Nasal Mucosa; Nasal Provocation Tests; Rhinitis, Allergic, Seasonal

Topics: Administration, Intranasal; Administration, Oral; Adult; Ampicillin; Asthma; Beclomethasone; Blood Cell Count; Body Temperature; Cromolyn Sodium; Drug Eruptions; Drug Hypersensitivity; Drug Industry; Environmental Exposure; Eosinophils; Humans; Isoproterenol; Male; Middle Aged; Neutrophils; Occupational Diseases; Penicillanic Acid; Penicillin G; Penicillins; Skin Tests; Spirometry