cortisol-succinate--sodium-salt and Anaphylaxis

Reports of corticosteroid sensitivity reactions are rare in the medical literature. We report an anaphylactoid reaction to hydrocortisone sodium succinate given intravenously which occurred on two occasions during treatment of a patient for asthma. Intradermal testing with a wide range of steroid preparations gave positive results with hydrocortisone sodium succinate, methylprednisolone sodium succinate, methylprednisolone sodium succinate and methylprednisolone acetate. No reactions occurred to dexamethasone sodium phosphate administered intravenously, prednisolone given orally or beclomethasone dipropionate by inhalation. Results of a radioallergosorbent test (RAST) were negative for hydrocortisone sodium succinate.

Topics: Administration, Inhalation; Adult; Anaphylaxis; Asthma; Beclomethasone; Dexamethasone; Humans; Hydrocortisone; Injections, Intravenous; Intradermal Tests; Male; Recurrence; Skin Tests

Topics: Adult; Allergens; Anaphylaxis; Animals; Bites and Stings; Epinephrine; Food Hypersensitivity; Humans; Hydrocortisone; Male; Polyglutamic Acid; Scyphozoa; Skin Tests

Despite their frequent use, systemic corticosteroids have rarely elicited immediate-type reactions.. We report two male patients, aged 26 and 70 years, respectively, with severe immediate-type hypersensitivity secondary to the administration of corticosteroids esterified with succinate.. Skin tests, basophil activation tests and challenge tests were performed for diagnostic evaluation.. In both patients, immediate-type skin test reactions were found to methylprednisolone sodium hemisuccinate (MSH) and prednisolone sodium hemisuccinate (PSH). In contrast, nonsuccinylated corticosteroids (including methylprednisolone and prednisolone in one patient) yielded no test reactions. Basophils from one patient exhibited a stimulated expression of the activation marker CD63 upon in vitro incubation with PSH or hydrocortisone sodium succinate, but not with hydrocortisone. Skin tests and basophil activation tests were negative in controls. One patient was challenged with the incriminated drugs. He developed flush, conjunctivitis, tachycardia and dyspnea 2 min after injection of MSH, and dyspnea shortly after intravenous administration of PSH. Oral and intravenous challenge tests with nonsuccinylated corticosteroids were tolerated well by both patients.. These case reports should alert clinicians to rare, but severe immediate-type reactions to corticosteroids, related to the succinate moiety in our patients. In case of allergic reactions to corticosteroids, it is mandatory to identify the causative agent and find safe alternatives.

Topics: Adrenal Cortex Hormones; Adult; Aged; Anaphylaxis; Anti-Inflammatory Agents; Basophil Degranulation Test; Drug Hypersensitivity; Humans; Hydrocortisone; Hypersensitivity, Immediate; Immunoglobulin E; Insect Bites and Stings; Male; Methylprednisolone Hemisuccinate; Prednisolone; Skin Tests; Succinates

Topics: Adult; Anaphylaxis; Anti-Inflammatory Agents; Asthma; Humans; Hydrocortisone; Injections, Intravenous; Male

Topics: Anaphylaxis; Anti-Inflammatory Agents; Child; Female; Humans; Hydrocortisone

Topics: Adult; Anaphylaxis; Female; Humans; Hydrocortisone; Japan; Male

Topics: Anaphylaxis; Asthma; Drug Interactions; Female; Humans; Hydrocortisone; Methylprednisolone; Methylprednisolone Hemisuccinate; Middle Aged; Status Asthmaticus

Topics: Adult; Anaphylaxis; Aspirin; Asthma; Drug Hypersensitivity; Humans; Hydrocortisone; Immunoglobulin E; Male

Anaphylactic reactions to hydrocortisone have been well described in adults, but have not been reported in children. We wish to report such a reaction in a 6-year-old girl who had a positive intradermal reaction to methylprednisolone. Control subjects were non-reactive. Previous literature is briefly reviewed and discussed.

Topics: Anaphylaxis; Asthma; Child; Female; Humans; Hydrocortisone; Infusions, Parenteral; Pruritus; Urticaria

Topics: Aminophylline; Anaphylaxis; Drug Therapy, Combination; Epinephrine; Histamine H1 Antagonists; Humans; Hydrocortisone; Prednisolone

Topics: Adult; Anaphylaxis; Aspirin; Asthma; Drug Hypersensitivity; Humans; Hydrocortisone; Male; Time Factors