prednisolone-hemisuccinate and Anaphylaxis

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

A Nigerian dwarf goat intended for the production of antibodies to staphylococcal enterotoxin-B exhibited classical signs of a type 1 anaphylactic reaction 2 to 3 min after parenteral introduction of this antigen. The exquisite sensitivity demonstrated in concert with the pathognomonic signs appeared to make the breed and species an excellent model for the further study and interpretation of this syndrome in domestic food animals.

Topics: Anaphylaxis; Animals; Enterotoxins; Epinephrine; Goat Diseases; Goats; Prednisolone; Staphylococcus aureus; Superantigens

Topics: Adult; Anaphylaxis; Asthma; Female; Humans; Hydrocortisone; Prednisolone