cortisol-succinate--sodium-salt and Drug-Hypersensitivity

Allergic anaphylactic (type I) reactions to corticosteroid medications are uncommon; however, a number of well-documented cases have been reported. We present a review of the literature, and report on two patients who suffered anaphylaxis after injections of corticosteroids. The first patient, a registered nurse, was finally found to be sensitive to all corticosteroid preparations containing carboxymethylcellulose, as well as the pure carboxymethylcellulose. The second patient had positive skin tests to hydrocortisone, hydrocortisone sodium succinate, methylprednisolone sodium succinate, and suxamethonium. Both patients were tested on two occasions; four normal subjects were tested in parallel, and did not elicit any positive skin reaction. In patients with systemic severe reactions to injectable corticosteroids, we recommend careful and comprehensive skin testing with most available corticosteroids, as well as the components of the injectables.

Topics: Adult; Drug Hypersensitivity; Female; Glucocorticoids; Heart Arrest; Humans; Hydrocortisone; Hypersensitivity, Immediate; Male; Skin Tests; Triamcinolone Acetonide; Urticaria

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

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

A case of a 73-year-old man with variant angina who developed chest pain and shock following an injection of sodium bicarbonate and hydrocortisone is reported. The electrocardiogram (ECG) during the chest pain attack revealed ST elevation in leads II, III and aVF. It returned to a normal pattern 10 min later. Coronary angiography, performed 2 hours after the anginal attack, showed no significant coronary arterial stenosis. One month later, an injection of ergonovine (16 micrograms) into the right and left coronary arteries induced spasms in segments 4 and 13, with ischemic ECG changes. Possible causes of the anginal attack are a coronary arterial spasm induced by the allergic reaction to hydrocortisone and/or serum alkalosis due to the sodium bicarbonate injection triggered by hyperventilation.

Topics: Aged; Angina Pectoris, Variant; Bicarbonates; Coronary Angiography; Coronary Vasospasm; Dizziness; Drug Hypersensitivity; Electrocardiography; Humans; Hydrocortisone; Injections, Intravenous; Male; Sodium; Sodium Bicarbonate

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; Anaphylaxis; Aspirin; Asthma; Drug Hypersensitivity; Humans; Hydrocortisone; Immunoglobulin E; Male

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

Cimetidine has recently proved useful in the prophylaxis of certain allergic and other histamine-mediated reactions. We have encountered a patient who had a serious cutaneous and respiratory reaction to Renografin-76 during cardiac catheterization. For the four days preceding his second catheterization, the patient was treated with prednisone, 30 mg daily, diphenhydramine, 25 mg orally, three times a day, intravenous diphenhydramine, 25 mg, three times a day, and Solu-Cortef, 500 mg, intravenously, every six hours. Despite this preparation, he developed an intense reaction to Renografin-76, which did not respond to further doses of Solu-Cortef and diphenhydramine in the catheterization laboratory. Cimetidine, 300 mg, in 100 ml of D5W over 15 minutes, rapidly reversed the entire cutaneous and respiratory phenomenon. In the future, strong consideration should be given to using cimetidine, in its intravenous form, as a routine medication in angiographic laboratories where radiographic contrast materials (RCM) are used. It may be helpful as a pretreatment for recognized RCM reactive patients when catheterization is essential.

Topics: Adult; Cardiac Catheterization; Cimetidine; Contrast Media; Diphenhydramine; Drug Hypersensitivity; Drug Therapy, Combination; Guanidines; Humans; Hydrocortisone; Male; Prednisone