cortisol-succinate--sodium-salt and Asthma

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: Administration, Inhalation; Aminophylline; Asthma; Bronchodilator Agents; Drug Therapy, Combination; Furosemide; Humans; Hydrocortisone; Infusions, Intravenous

In a multicenter, randomized, double-blind study, we compared the effects of nebulized (5 mg x 2) and intravenous (0.5 mg) albuterol (salbutamol) over 1 h in 47 patients admitted to hospital with severe acute asthma defined as a peak expiratory flow (PEF) below 150 L/min and hypercapnia (Pa(CO2) > or = 40 mm Hg). Additional treatment included nasal oxygen and hydrocortisone succinate. The efficacy was assessed after 1 h. In the group treated by nebulization (NEB group, n = 22) 19 (86%) patients (95% confidence interval: 65 to 97%) had been treated successfully according to predefined criteria, versus 12 (48%) patients (95% confidence interval: 28 to 69%) in the intravenously treated group (i.v. group, n = 25), p = 0.006. The mean increase in PEF was greater in the NEB group than in the i.v. group (+107 +/- 94 L/min versus +42 +/- 66 L/min, p = 0.01) as well as the decrease in Pa(CO2) values (-10 +/- 5 mm Hg versus -2 +/- 12 mm Hg, p < 0.01). Beta agonist-induced hypokalemia was more pronounced in the i.v. group than in the NEB group. We conclude that, in hypercapnic acute asthma, the nebulized route has a greater efficacy and fewer side effects than the intravenous route.

Topics: Acute Disease; Administration, Inhalation; Adolescent; Adult; Aged; Albuterol; Analysis of Variance; Asthma; Carbon Dioxide; Combined Modality Therapy; Confidence Intervals; Double-Blind Method; Drug Monitoring; Female; Humans; Hydrocortisone; Hypercapnia; Hypokalemia; Infusions, Intravenous; Male; Middle Aged; Nebulizers and Vaporizers; Oxygen Inhalation Therapy; Peak Expiratory Flow Rate; Severity of Illness Index; Time Factors

Improvements in asthma diagnosis and management require deeper understanding of the heterogeneity of the complex airway inflammation. We hypothesise that differences in the two major inflammatory phenotypes of asthma; eosinophilic and neutrophilic asthma, will be reflected in the lung protein expression profile of murine asthma models and can be delineated using proteomics of bronchoalveolar lavage (BAL).. BAL from mice challenged with ovalbumin (OVA/OVA) alone (standard model of asthma, here considered eosinophilic) or OVA in combination with endotoxin (OVA/LPS, model of neutrophilic asthma) was analysed using liquid chromatography coupled to high resolution mass spectrometry, and compared with steroid-treated animals and healthy controls. In addition, conventional inflammatory markers were analysed using multiplexed ELISA (Bio-Plex™ assay). Multivariate statistics was performed on integrative proteomic fingerprints using principal component analysis. Proteomic data were complemented with lung mechanics and BAL cell counts.. Several of the analysed proteins displayed significant differences between the controls and either or both of the two models reflecting eosinophilic and neutrophilic asthma. Most of the proteins found with mass spectrometry analysis displayed a considerable increase in neutrophilic asthma compared with the other groups. Conversely, the larger number of the inflammatory markers analysed with Bio-Plex™ analysis were found to be increased in the eosinophilic model. In addition, major inflammation markers were correlated to peripheral airway closure, while commonly used asthma biomarkers only reflect central inflammation.. Our data suggest that the commercial markers we are currently relying on to diagnose asthma subtypes are not giving us comprehensive or specific enough information. The analysed protein profiles allowed to discriminate the two models and may add useful information for characterization of different asthma phenotypes.

Topics: Animals; Anti-Inflammatory Agents; Asthma; Biomarkers; Bronchial Provocation Tests; Bronchoalveolar Lavage Fluid; Disease Models, Animal; Eosinophils; Female; Hydrocortisone; Inflammation; Inflammation Mediators; Leukocyte Count; Lipopolysaccharides; Mass Spectrometry; Methacholine Chloride; Mice; Mice, Inbred BALB C; Neutrophils; Ovalbumin; Phenotype; Protein Array Analysis; Proteome; Respiratory Mechanics

Glucocorticoids (GC) remain the first choice of treatment in asthma, but GC therapy is not always effective and is associated with side effects. In a porcine study in our laboratory, simultaneous administration of GC and nitric oxide (NO) attenuated the endotoxin-induced inflammatory response and made GC treatment more effective than inhaled NO or steroids alone. In the present study, we aimed to further investigate the interactions between NO and GC treatment in two murine models of asthma. Inflammation was induced by endotoxin, ovalbumin, or a combination of both. With an animal ventilator and a forced oscillation method (FlexiVent), lung mechanics and airway reactivity to methacholine in response to various treatments were assessed. We also describe histology and glucocorticoid receptor (GR) protein expression in response to inhaled NO treatment [40 ppm NO gas or NO donors sodium nitroprusside (SNP) or diethylamine NONOate (DEA/NO)]. SNP and GC provided protection against bronchoconstriction to a similar degree in the model of severe asthma. When GC-treated mice were given SNP, maximum airway reactivity was further reduced. Similar effects were seen after DEA/NO delivery to GC-treated animals. Using 1-H-[1,2,4]-oxadiazolo-[4,3-a]-quinoxalin-1-one (ODQ), a soluble guanylate cyclase inhibitor, we found this effect of NO donors to be mediated through a cGMP-independent mechanism. In the severe model, prolonged NO treatment restored or even increased the nuclear levels of GR. In conclusion, in our murine model of severe asthma GC treatment provided protection to only a limited degree against bronchoconstriction, while concomitant treatment with a NO donor was markedly more potent than the use of either NO or GC alone.

Topics: Administration, Inhalation; Animals; Anti-Asthmatic Agents; Asthma; Bronchial Provocation Tests; Bronchoconstriction; Bronchoconstrictor Agents; Cyclic GMP; Disease Models, Animal; Drug Therapy, Combination; Enzyme Inhibitors; Female; Glucocorticoids; Guanylate Cyclase; Hydrazines; Hydrocortisone; Injections, Intraperitoneal; Lipopolysaccharides; Methacholine Chloride; Mice; Mice, Inbred BALB C; Nitric Oxide; Nitric Oxide Donors; Nitroprusside; Ovalbumin; Oxadiazoles; Pneumonia; Quinoxalines; Receptors, Cytoplasmic and Nuclear; Receptors, Glucocorticoid; Respiration, Artificial; Respiratory Mechanics; Soluble Guanylyl Cyclase

Topics: Acidosis; Acute Disease; Adult; Albuterol; Anti-Asthmatic Agents; Asthma; Biomarkers; Combined Modality Therapy; Creatine Kinase, MM Form; Female; Fentanyl; Humans; Hydrocortisone; Hypnotics and Sedatives; Hypoxia; Male; Midazolam; Respiration, Artificial; Respiratory Muscles; Rhabdomyolysis

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

Corticosteroids are the basis of treatment of asthma; they interrupt the development of inflammation. However, corticosteroids can also be at the origin of severe allergical reactions.. A 40 Year-old woman, during hospitalisation for severe acute asthma, presented with an allergy to hydrocortisone hemisuccinate (HCHS) in the form of generalised pruritus with, on examination, cutaneous mucosal lesions in the form of purpura and ecchymoses on the abdomen and the upper and lower limbs. The substitution of HCHS led to the return to normal.. Allergic reactions to corticosteroids, generally paradoxical, were for many Years ignored and their existence was controversial. They were usually secondary to the administration of injectable substances containing hydrocortisone hemisuccinate or methylprednisolone. Their physiopathology remains a mystery. Their management requires the immediate and permanent withdrawal of the product implied, antihistamine and adrenalin in the case of shock and symptomatic treatment.

Topics: Acute Disease; Adult; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Arachidonic Acids; Asthma; Biopsy; Diagnosis, Differential; Drug Eruptions; Drug Monitoring; Ecchymosis; Female; Humans; Hydrocortisone; Immunoglobulin E; Medical History Taking; Prednisone; Pruritus; Purpura; Treatment Outcome

The surgical treatment of emphysematous lung bullae is usually contraindicated in patients with severe bronchial asthma. However, we recently encountered a patient who required surgery due to the development of respiratory distress despite treatment with bronchodilators and low-dose prednisolone (5 mg/day). During the first operation, bronchospasm occurred with anesthesia. After suppression of the asthmatic symptoms for 2 weeks with high-dose prednisolone (25 mg/day), the giant bullae could be resected safely. Thus, the preoperative resolution of asthma to decrease the probability of an attack is indispensable for such patients.

Topics: Adult; Aminophylline; Anti-Inflammatory Agents; Asthma; Bronchial Spasm; Bronchodilator Agents; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Hydrocortisone; Intraoperative Complications; Male; Prednisolone; Premedication; Pulmonary Emphysema; Tomography, X-Ray Computed

Steroid is the key drug in the asthma therapy but not well known to play the role on the airway inflammatory cells. We examined sputum cells of acute excerbated 11 chronic adult asthmatics before and 2-3 hours after intravenous steroid and aminophylline therapy. There was no changes in the percent count of living cell, epithelial cell, metachlomatic cell, macrophage and neutrophil before and after treatment. Lymphocyte was 3.3 +/- 6.5% before and 2.6 +/- 2.0% after treatment. CD4 and CD25 double positive cell (CD4+/CD25+) was 0.7 +/- 0.5 and 1.2 +/- 0.9% and CD8+/CD25+ cell was 0.4 +/- 0.4 and 0.6 +/- 0.5% before and after treatment respectively. These changes were not significant. Eosinophil percent count did not decrease significantly but EG1+/EG2+ cell decreased from 6.7 +/- 7.8 to 4.3 +/- 5.2% significantly (p < 0.05). In the light of no decrease of activated T lymphocytes (CD25+ cells), we concluded that failure of tissue eosinophil response to lymphokines might result in a decrease in activated eosinophil count.

Topics: Adult; Aged; Aminophylline; Anti-Inflammatory Agents; Asthma; Bronchi; Cell Count; Chronic Disease; Female; Humans; Hydrocortisone; Infusions, Intravenous; Male; Middle Aged; Sputum

This is a report of a male patient who had an anaphylaxia-like reaction to hydrocortisone sodium hemisuccinate (Solu-Cortef). A 32-year-old male with aspirin sensitivity was treated for moderate wheezing with 200 mg Solu-Cortef given intravenously. After this treatment, his condition deteriorated acutely and he was admitted to our hospital. Intradermal skin tests revealed positive immediate reactions to Solu-Cortef, Saxizon, Solu-Medrol and Predonine. Challenge tests with 100 mg Solu-Cortef and Saxizon injection showed 34% and 27% decrease, respectively in FEV1 15 min after injection. These results suggest that succinylation of steroids resulted in allergic reaction to steroids in this patient.

Topics: Adult; Aspirin; Asthma; Bronchial Spasm; Drug Hypersensitivity; Humans; Hydrocortisone; Infusions, Intravenous; Male

This is a report of a female patient who had an anaphylaxis-like reactions to hydrocortisone sodium succinate (Saxizon). A 31-year-old female with intrinsic bronchial asthma and aspirin sensitivity was admitted to our hospital because of an episode of asthmatic attack. The patient had had episodes of dyspnea since 1976, and had been treated with oral bronchodilators and intermittent corticosteroids. After admission, she was given 100 mg of hydrocortisone sodium succinate intravenously. A few minutes later she developed severe bronchospasm and lost consciousness. An endotracheal tube was inserted and she was mechanically ventilated for 2 hours. The patient recovered after 1 hour. An inhalation challenge test with Sulpyrin was positive. When the provocation challenge test with 100 mg of hydrocortisone sodium succinate (Saxizon) injection was performed, she developed subjective and objective evidence of bronchospasm. Intradermal skin test revealed positive immediate reactions to Saxizon, Solu-cortef, Predonine. It is suggested that she had immediate hypersensitivity to hydrocortisone sodium succinate, but the mechanism of this anaphylaxis-like reaction to steroids is not certain.

Topics: Adult; Aspirin; Asthma; Bronchial Spasm; Drug Hypersensitivity; Female; Humans; Hydrocortisone

Topics: Adult; Aged; Asthma; Female; Humans; Hydrocortisone; Male; Muscular Dystrophies; Pancuronium; Status Asthmaticus

Topics: Adrenocorticotropic Hormone; Adult; Asthma; Bronchitis; Cosyntropin; Female; Humans; Hydrocortisone; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Respiration

Topics: Alkalosis; Asthma; Child; Female; Humans; Hydrocortisone; Hydroxybutyrates; Sodium Oxybate

Hydrocortisone succinate and hydrocortisone are chromatographed with a mobile phase consisting of sodium acetate/acetonitrile (77/23, by vol), the effluent being monitored at 254 nm. p-Hydroxybenzoate-N-propyl is used as the internal standard. Detection limits are 0.5 mg/L for hydrocortisone succinate, 0.2 mg/L for hydrocortisone. For five different concentrations the respective mean analytical recoveries were 88.2% and 100.5%, the mean intra-assay CVs for slope 3.9% and 2.1%, and the inter-assay CVs 3.3% and 1.6%. Simultaneous measurement of hydrocortisone and its succinate ester may be useful for pharmacokinetic study. Concentration-time profiles for plasma after administration of hydrocortisone sodium succinate are presented.

Topics: Adolescent; Asthma; Chromatography, High Pressure Liquid; Humans; Hydrocortisone; Kinetics; Male; Radioimmunoassay

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

Topics: Adult; Asthma; Female; Humans; Hydrocortisone; Immunoglobulin E; Injections, Intravenous; Radioallergosorbent Test; Skin Tests

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

Topics: Acute Disease; Adolescent; Adult; Airway Resistance; Asthma; Female; Humans; Hydrocortisone; Male; Middle Aged

Churg-Strauss vasculitis in remission for 4 1/2 years recurred, with new, previously undescribed features, after a lapse in corticosteroid therapy. Bilateral exophthalmos, unilateral hearing loss, and nasal obstruction accompanied fever, severe asthma, and palpable purpura. Leukocytosis with eosinophilia, an elevated ESR, hyperimmunoglobulinemia E, an pulmonary infiltrates were seen again. Circulating immune complexes were detected, and microamyloid deposits were found in the conjunctiva and skin. All clinical and laboratory manifestations responded to corticosteroid therapy. Monitoring the levels of IgE may add a diagnostic and prognostic feature to the classification of necrotizing vasculitides.

Topics: Adult; Amyloid; Antigen-Antibody Complex; Asthma; Exophthalmos; Female; Hearing Loss; Humans; Hydrocortisone; Immunoglobulin E; Nose Diseases; Polyarteritis Nodosa; Prednisone; Recurrence; Syndrome

Eleven patients with intrinsic asthma and aspirin sensitivity were challenged with intravenous hydrocortisone sodium succinate (Solu-Cortef; the Upjohn Co., Kalamazoo, Mich.). Three patients showed definite evidence of bronchospasm, which was easily reversed by subcutaneous administration of epinephrine. Evidence is presented which suggests that this reaction was not caused by other constituents of the preparation but rather was caused by Solu-Cortef alone. No atopy was demonstrated in the group as a whole, and the reaction observed was probably nonallergic in nature. We suggest the replacement of intravenous hydrocortisone sodium succinate with dexamethasone in the treatment of such a population.

Topics: Adult; Aspirin; Asthma; Bronchial Spasm; Dexamethasone; Female; Forced Expiratory Volume; Humans; Hydrocortisone; Injections, Intravenous; Male; Middle Aged; Vital Capacity

Topics: Asthma; Child; Humans; Hydrocortisone; Infant