cortisol-succinate--sodium-salt and Urticaria

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

We present the case of a woman with 'empty sella syndrome' who experienced generalized urticaria after the administration of sodium succinate hydrocortisone in two episodes.. The patient underwent an allergological evaluation (prick, intradermal, and patch tests) with hydrocortisone sodium succinate, hydrocortisone acetate, hydrocortisone, hydrocortisone sodium phosphate, methylprednisolone hemisuccinate, methylprednisolone, and preservatives held in the formulation of sodium succinate hydrocortisone (sodium phosphate and methyl-p-oxybenzoate). The basophil activation test (BAT) was also performed with hydrocortisone. The single-blind i.m. challenge test was performed with hydrocortisone sodium phosphate in 4 days.. Skin test with hydrocortisone sodium succinate and methylprednisolone hemisuccinate was positive. On the contrary, allergological tests performed with other formulations of the same steroids and preservatives were negative. These results showed an immediate-type allergy to succinate ester. BAT was not helpful to improve our diagnostic work-up because our patient was a 'nonresponder.' Therefore, the patient underwent successfully to a challenge test with hydrocortisone sodium phosphate.. Patients with succinate ester allergy can tolerate alternative corticosteroids without ester.

Topics: Anti-Allergic Agents; Betamethasone; Drug Eruptions; Emergency Treatment; Empty Sella Syndrome; Female; Humans; Hydrocortisone; Hypersensitivity, Immediate; Infusions, Intravenous; Middle Aged; Skin Tests; Urticaria

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