pulmicort and Dermatitis--Allergic-Contact

An alternative view of corticosteroid cross-reactivity is proposed, based on 2 immune recognition sites on the corticosteroid molecule, 1 influenced by C 6/9 substitution and 1 by C 16/17 substitution. A case report is adduced in support of such a hypothesis.

Topics: Administration, Topical; Adult; Allergens; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Dermatologic Agents; Female; Humans; Hydrocortisone; Molecular Structure

It is only in the past 10 years that the allergenic potential of topical corticosteroids has been fully realized. This has an important impact on the management of patients with chronic eczematous eruptions. Nonhalogenated topical steroids are more frequent sensitizers than halogenated molecules. Tixocortol pivalate and budesonide should be added to the standard series of patch test allergens. The topical steroid products that the patient has used should also be tested. If a patient has a positive reaction to tixocortol pivalate and/or budesonide then further patch testing with a commercial corticosteroid series should be undertaken.

Topics: Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; False Negative Reactions; Glucocorticoids; Humans; Hydrocortisone; Patch Tests

Contact allergy to corticosteroids has recently gained increased attention.. Five cases of contact dermatitis due to budesonide, a nonhalogenated steroid, are described. The Japanese literature was reviewed for reports on this allergy, and the occurrence due to budesonide was compared with that of other dermocorticosteroids.. Budesonide use can cause contact dermatitis.. Although budesonide may be beneficial because of its anti-inflammatory effects, clinicians should be alert to its potential for causing contact dermatitis.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Chronic Disease; Dermatitis; Dermatitis, Allergic Contact; Dermatitis, Seborrheic; Drug Eruptions; Eczema; Erythema; Female; Glucocorticoids; Humans; Japan; Leg Dermatoses; Male; Pregnenediones; Psoriasis

We cannot as yet fully answer the question of the safety of the new corticosteroids. Budesonide is frequently found to be an allergen now that it is being marketed, and it can certainly serve as a primary sensitizer. For the other new corticosteroids, too, we already had numerous positive tests even before they were marketed. This must be considered cross-sensitivity. We will have to wait to see whether or not they are primary sensitizers. For the pharmaceutical industry, there is one more challenge in the development of new corticosteroids: In addition to finding more effective corticosteroids with the fewest "classic" side effects, the industry will also have to identify the least sensitizing molecules.

Topics: Administration, Topical; Adrenal Cortex Hormones; Allergens; Androstadienes; Animals; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Fluticasone; Glucocorticoids; Humans; Mometasone Furoate; Prednisolone; Pregnadienediols; Pregnenediones

Up to 5% of patients with dermatitis who are consecutively patch tested are allergic to one or more corticosteroids. However, few reports of allergic mucosal and skin symptoms in patients with asthma and rhinitis caused by inhaled corticosteroids exist.. Our purpose was to determine whether inhalation of budesonide would result in reactivation of patch test reactions caused by budesonide.. The study, which was randomized, double-blind, and placebo-controlled, was ethically reviewed by the Medical Faculty, University of Lund, Sweden. Fifteen nonasthmatic patients who were initially given a diagnosis of budesonide hypersensitivity on patch testing from less than 1 up to 8 years before the study were provoked with budesonide or placebo by inhalation 6 weeks after they had been patch tested with budesonide, its R and S diastereomers, and potentially cross-reacting substances. Lung function was studied by using spirometry and repeated peak expiratory flow measurements.. In 4 of 7 patients who inhaled budesonide, reactivation of previously positive patch test reactions was noted within 24 hours, in contrast to 0 of 8 patients who inhaled placebo (P =.026). No adverse pulmonary responses could be detected.. This study shows that allergic skin reactions may occur in patients with contact allergy to budesonide when inhaled forms of the drug are used.

Topics: Administration, Inhalation; Adult; Allergens; Bronchial Provocation Tests; Budesonide; Dermatitis, Allergic Contact; Double-Blind Method; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Patch Tests; Peak Expiratory Flow Rate; Respiratory Function Tests; Spirometry

Contact allergy to topical corticosteroids on patch testing is well recognized, but the clinical significance is uncertain.. To determine the clinical relevance of contact allergy to topical corticosteroids.. Seven patients hypersensitive to both budesonide and nickel repeatedly applied budesonide, betamethasone valerate or the common base for both corticosteroids to areas of experimentally induced nickel dermatitis. Nineteen controls allergic to nickel, but not budesonide went through the same procedure.. Seventy-one per cent of the budesonide-allergic individuals experienced distant ipsilateral flares of toxicoderma-like eruptions, in addition to a severe deterioration of the experimental dermatitis treated with budesonide, i.e. increased erythema, and abundant papules and vesicles. The areas of dermatitis in all of the 19 controls healed uneventfully.. The clinical relevance of a contact allergy to budesonide was thus substantiated.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Double-Blind Method; Drug Administration Schedule; Female; Glucocorticoids; Humans; Middle Aged; Nickel; Patch Tests; Severity of Illness Index; Skin Tests

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Diagnosis-Related Groups; Drug Hypersensitivity; European Union; Female; Glucocorticoids; Humans; Male; Patch Tests

Topics: Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Hypersensitivity; Humans; Hydrocortisone; Patch Tests; Skin

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Glucocorticoids; Humans; Patch Tests; Sensitivity and Specificity

Topics: Adrenal Cortex Hormones; Budesonide; Dermatitis, Allergic Contact; Glucocorticoids; Humans; Patch Tests

Topics: Allergens; Budesonide; Dermatitis, Allergic Contact; Humans

Patients are consecutively screened for contact allergy to corticosteroids with budesonide and tixocortol-21-pivalate in the European baseline series. Centres using TRUE Test also include hydrocortisone-17-butyrate. A supplementary corticosteroid patch test series is used in case of suspicion of corticosteroid contact allergy or when a marker of corticosteroid contact allergy is positive.. The aims were to evaluate (1) the efficacy of corticosteroids in the TRUE Test and (2) co-sensitization patterns.. This retrospective study analysed patients patch tested with TRUE Test corticosteroids plus supplementary corticosteroid series in the period 2006-2020 at the Department of Dermatology and Allergy Centre, Odense University Hospital.. Of 1852 patients tested, 119 were sensitised to TRUE Test corticosteroids and supplementary testing found additional reactions to other corticosteroids in 19 of 119 patients. TRUE Test corticosteroids gave more positive and stronger reactions compared to allergens in petrolatum/ethanol. Fourteen percent of sensitised patients were co-sensitised to multiple corticosteroid groups. Baeck group 3 corticosteroids accounted for 9 of 16 patients not identified by TRUE Test.. Budesonide, hydrocortisone-17-butyrate, and tixocortol-21-pivalate in combination are sensitive corticosteroid markers. In case of clinical suspicion of corticosteroid contact allergy, patch testing with supplementary corticosteroids is highly recommended.

Topics: Adrenal Cortex Hormones; Allergens; Budesonide; Dermatitis, Allergic Contact; Humans; Hydrocortisone; Patch Tests; Retrospective Studies

Topics: Allergens; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Atopic; Humans; Patch Tests

Allergic contact dermatitis to corticosteroids can be a challenging diagnosis as corticosteroids are used in the treatment of dermatitis. The prevalence of contact allergy to corticosteroid varies between previous studies.. To study the prevalence of sensitization to budesonide, tixocortol-21-pivalate and hydrocortisone-17-butyrate in a Danish patient population from 2006-2020, cross-sensitization, risk factors and clinical relevance.. A retrospective analysis of patch test data and MOAHLFA index was performed among 6823 patients consecutively patch tested with TRUE test as part of the baseline series.. A positive patch test for corticosteroids was found in 185 patients (1.2% budesonide, 1.6% tixocortol-21-pivalate, 1.0% hydrocortisone-17-butyrate) without gender difference. For women, the prevalence of tixocortol-21-pivalate sensitization increased significantly from 1.3% in 2006-2008 to 2.9% in 2018-2020. Tixocortol-21-pivalate sensitization had more frequently clinical relevance in women (61.3%) compared to men (34.5%). Age above 40 years was positively associated to corticosteroid sensitization. Budesonide and hydrocortisone-17-butyrate accounted for 67.7% of co-sensitizations.. The prevalence of corticosteroid sensitization was 2.7%. Age was the only risk factor for corticosteroid sensitization. The frequency of corticosteroid sensitization was stabile over time except for tixocortol-21-pivalate sensitization for women. About one third of sensitized patients had co-sensitizations to other corticosteroid groups.

Topics: Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Budesonide; Denmark; Dermatitis, Allergic Contact; Female; Humans; Hydrocortisone; Male; Patch Tests; Prevalence; Retrospective Studies

Budesonide was included in the European Baseline Series in 2000 as the most suitable marker forcorticosteroid hypersensitivity. In the last two decades, a decreasing trend of budesonide allergy has been observed.. To estimate the prevalence of positive patch test reactions to budesonide in a large, Italian patch test population, characterizing patients according to MOAHLFA index and evaluating the benefit with extended readings of budesonide patch test.. Retrospective analysis of patient demographics and patch test results over a 2-year period (2018-2019) was performed at 14 patch test clinics in Italy.. Ninety out of 14 544 (0.6%) patients reacted to budesonide 0.01% pet.. Positive reactions were mild in 54.4% and late readings at day 7 showed new positive reactions in 37.8% of patients. The MOAHLFA index showed a significant positive association with male gender, atopic dermatitis, and age >40 years and a significant negative association with hand and face dermatitis.. We documented a low prevalence of budesonide allergy in Italy, confirming its decreasing trend recently reported in the literature. Nevertheless, budesonide needs to be maintained in the baseline series for its good ability to detect corticosteroid sensitization.

Topics: Adult; Age Distribution; Aged; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Occupational; Female; Humans; Italy; Male; Middle Aged; Patch Tests; Prevalence; Retrospective Studies; Sex Distribution

Topical corticosteroids are an emerging cause of allergic contact dermatitis in children that may often be missed. It is important to consider patch testing with corticosteroids to detect allergic contact dermatitis in patients with persistent or worsening of dermatitis despite topical corticoseroid treatment. However, delayed reactions (>7 days) to topical corticosteroids may occur, leading to false-negative reactions and misdiagnosis. Herein, we report a case of an 8-year-old girl who developed a positive reaction to budesonide on day 12 of patch testing.

Topics: Administration, Topical; Adrenal Cortex Hormones; Budesonide; Child; Dermatitis, Allergic Contact; Female; Humans; Patch Tests

Topics: Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Female; Glucocorticoids; Humans; Male; Middle Aged; Patch Tests

Topics: Betamethasone; Budesonide; Dermatitis, Allergic Contact; Glucocorticoids; Humans

Concomitant allergic reactions to multiple drugs are uncommon. We report the case of a 66-year-old woman who presented with concomitant sensitization to inhaled budesonide and oral nystatin presenting as allergic contact stomatitis and systemic allergic contact dermatitis. It is notable that one of the reactions was caused by oral nystatin, which generally is not considered to be allergenic due to its poor intestinal absorption. Diagnoses were confirmed on patch testing with histologic examination along with oral challenge testing. We also used challenge testing to rule out cross-reactivity among nystatin and other macrolide drugs, both antifungals and antibiotics.

Topics: Administration, Inhalation; Aged; Antifungal Agents; Budesonide; Candidiasis, Oral; Cough; Dermatitis, Allergic Contact; Female; Glucocorticoids; Humans; Nystatin; Stomatitis

Topics: Adenoids; Anti-Allergic Agents; Budesonide; Child, Preschool; Dermatitis, Allergic Contact; Diagnosis, Differential; Erythema Multiforme; Face; Glucocorticoids; Humans; Hydrocortisone; Hypertrophy; Male; Nebulizers and Vaporizers; Skin Tests

Allergic contact dermatitis is the most common adverse reaction caused by topical drugs.. To study the demographic characteristics and lesion locations of patients with iatrogenic dermatitis, and to analyse contact allergy to active principles and trends in frequencies over the years.. Between 1990 and 2014, 14 911 patients were patch tested with the European baseline series. Patients with a presumed iatrogenic cause were often tested with a pharmaceutical series, and, if indicated, with photo-patch tests. Most were also tested with the topical products to which they had been exposed, along with their ingredients.. Eight thousand three hundred and seventy-four (56%) patients tested positively, and 2600 (17.4%, 95%CI: 16.8-18.0%) of all patients suffered from iatrogenic contact dermatitis. The most important primary sites of dermatitis were the legs, face, and hands. The most common sensitizers included topical antibiotics, antiseptics, and corticosteroids. The most frequent baseline allergens in this subgroup were budesonide, neomycin, and benzocaine, although with a decreasing trend over the years. Many other allergens from different pharmacological classes were identified.. With a prevalence of 17.4% of consecutive patients, iatrogenic contact dermatitis is a frequent diagnosis in patients attending a general patch test clinic, involving one-third of the patients with at least one positive reaction.

Topics: Administration, Cutaneous; Administration, Topical; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Anesthetics, Local; Anti-Bacterial Agents; Anti-Infective Agents, Local; Belgium; Benzocaine; Budesonide; Child; Child, Preschool; Dermatitis, Allergic Contact; Dermatitis, Irritant; Facial Dermatoses; Female; Glucocorticoids; Hand Dermatoses; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Leg Dermatoses; Male; Middle Aged; Neomycin; Patch Tests; Prevalence; Retrospective Studies; Young Adult

Topics: Adult; Budesonide; Chronic Disease; Cross Reactions; Dermatitis, Allergic Contact; Female; Glucocorticoids; Hand Dermatoses; Humans; Hydrocortisone; Patch Tests; Prednisolone

Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic.. Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period.. We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction.. The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids.

Topics: Adrenal Cortex Hormones; Adult; Aged; Allergy and Immunology; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Occupational; Drug Hypersensitivity; Female; Hand Dermatoses; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Male; Middle Aged; Molecular Structure; Outpatient Clinics, Hospital; Patch Tests; Retrospective Studies; Spain; Tertiary Care Centers

Delayed allergic hypersensitivity reactions have classically been described as type IV reactions, which are caused by T cells; however, the respective roles of CD4(+) and CD8(+) cells are yet to be defined. A central role for CD8(+) cytotoxic T cells as effector cells has been suggested.. To determine the type of T cell involved in corticosteroid allergy.. We analysed the kinetics of T cell recruitment and the cytokine production profile in positive patch tests of 27 corticosteroid-sensitized patients, as compared with control sites and control subjects. Skin biopsies, collected at 8, 24 and 48 hr following drug application, were embedded in paraffin for histological and immunohistological staining, and, in some cases, also deep-frozen for gene expression analyses.. CD3(+) T cells were rapidly recruited in concert with the positivity of the patch test sites. High levels of interleukin (IL)-4, IL-5 and, to a lesser extent, interferon-γ suggested that both Th2 and Th1 cytokines were implicated. IL-4 was also produced by γδ T cell receptor (TCR) lymphocytes.. This study showed that, in allergic contact dermatitis caused by corticosteroids, the inflammatory infiltrate is composed of CD3(+) T cells with a predominant Th2 cytokine profile, among which IL-4 is also produced by γδ TCR lymphocytes.

Topics: Adult; Aged; Biomarkers; Biopsy; Budesonide; Case-Control Studies; CD3 Complex; Dermatitis, Allergic Contact; Drug Eruptions; Female; Flow Cytometry; Glucocorticoids; Humans; Hydrocortisone; Immunohistochemistry; Interferon-gamma; Interleukin-4; Interleukin-5; Linear Models; Logistic Models; Male; Middle Aged; Patch Tests; Receptors, Antigen, T-Cell, gamma-delta; Reverse Transcriptase Polymerase Chain Reaction; Skin; T-Lymphocytes

Topics: Administration, Inhalation; Adult; Asthma; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Female; Glucocorticoids; Humans; Male; Middle Aged; Patch Tests; Pregnenediones

In order to map the frequency of contact hypersensitivity (CH) to epoxy resin, methyldibromoglutaronitrile (MDBGN), tixocortol pivalate (TP) and budesonide patch tests were carried out.. The tests were performed in 1448 patients. Most patients belong to the allergic and irritative contact dermatitis groups. The tests were administered with the allergens epoxy resin 1%, MDBGN 0.3%, TP 1% and budesonide 0.1%, applied on the back. Reactions were evaluated at 40 min, on day 2 (D2), day 3 (D3) and day 4 (D4). In the patients of the Dept. of Dermatology, Venerology and Dermatooncology of Semmelweis University (patients number =1073) reactions were evaluated on day 7 as well.. Epoxy resin elicited immediate reactions in 1 patient at 40 min. Further evaluations showed no difference on D3, D4 and D7 with a frequency of CH of 1.03%. Patch testing for MDBGN did not provoke immediate reactions, evaluations showed an increasing hypersensitivity rate (D2: 0.93%; D7:1.77%). Patch tests with TP yielded no immediate reactions, the frequency of CH increased from 0.47% (D2) to 2.01% (D7). No immediate reactions were observed by budesonide; an increase was seen in frequency of CH (D2:0.93% to D7:3.84%). CH to the studied allergens was observed mostly in allergic contact dermatitis group, to budesonide in irritative contact dermatitis and in atopic dermatitis groups as well.. The data of the present study are the first results about this four allergens in Hungary and to our knowledge from our region as well.

Topics: Allergens; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Contact; Dermatitis, Irritant; Epoxy Resins; Humans; Hungary; Hydrocortisone; Hypersensitivity, Immediate; Nitriles; Patch Tests; Preservatives, Pharmaceutical; Urticaria

Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability.. To estimate the prevalence of tixocortol-21-pivalate, budesonide and hydrocortisone-17-butyrate allergy in a Danish patch test population and characterize individuals with corticosteroid allergy.. Three thousand five hundred and ninety-four patients were patch tested with tixocortol-21-pivalate, budesonide, and hydrocortisone-17-butyrate. Characterization was performed according to the MOAHLFA index and duration of disease.. Two per cent had a steroid allergy: 0.8% had a tixocortol-21-pivalate allergy, 1% a budesonide allergy, and 1% a hydrocortisone-17-butyrate allergy. Tixocortol-21-pivalate and budesonide allergy were associated with atopic dermatitis in crude analyses, but only tixocortol-21-pivalate allergy and atopic dermatitis remained associated in adjusted analyses. Leg dermatitis was uniquely associated with tixocortol-21-pivalate allergy. Hydrocortisone-17-butyrate allergy was associated with duration of disease in both crude and adjusted analyses.. Chronic dermatoses (atopic dermatitis and leg dermatitis) were identified as risk factors for group A corticosteroid allergy, probably because of more pronounced exposure to group A steroids resulting from ease of access that is exploited by patients with a chronic dermatosis. The duration of disease rather than the dermatosis itself seemed to be important for group B and D2 corticosteroid allergy.

Topics: Adult; Budesonide; Chronic Disease; Denmark; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Occupational; Dermatologic Agents; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hydrocortisone; Leg Dermatoses; Male; Middle Aged; Patch Tests; Prevalence; Risk Factors

Topics: Allergens; Budesonide; Dermatitis, Allergic Contact; Humans; Hydrocortisone; Patch Tests; Probability; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Skin Tests; Statistics, Nonparametric

Inhalation corticosteroids (CSs), despite their wide use, rarely cause sensitization in subjects administering them.. To determine the cause of sensitization and/or of allergic contact dermatitis which occurred in air-exposed body areas of patients reacting to corticosteroids and to budesonide, in particular.. We reviewed the patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K.U. Leuven Dermatology department during an 18-year period.. Fifteen subjects, not themselves treated by budesonide-containing aerosols, but taking care of/or living together with patients who used them because of a chronic respiratory affection, appeared to have been sensitized by airborne exposure and/or presented with airborne allergic contact dermatitis from them.. Air exposure to inhalation corticosteroids used 'by proxy' and to budesonide, in particular, needs to be taken into account as a potential cause of primary sensitization and/or airborne allergic contact dermatitis, sometimes also in an occupational context.

Topics: Adult; Aerosols; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Occupational; Drug Eruptions; Family Health; Female; Humans; Male; Middle Aged; Retrospective Studies

Topics: Administration, Inhalation; Adult; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Occupational; Female; Humans; Particulate Matter; Patch Tests; Risk Factors; Sensitivity and Specificity

Inhaled corticosteroids are widely used in allergic asthma and rhinitis. They are most often used alone or sometimes in association. Allergic side-effects of inhaled corticosteroids are less frequent than those of topical corticosteroids. We report a case of a connubial dermatitis to a budesonide spray.. A 3-year old boy was treated for asthma by budesonide (Pulmicort) and terbutaline (Bricanyl) aerosols with an inhalation chamber (Babyhaler). From the fourth day of treatment onwards, his mother had swollen and itchy lesions on the face with conjunctivitis several hours after the administration of the corticosteroids using the inhalation chamber. The last eruptions were marked by extensive lesions. The patient reported a worsening of her eruption when she was treated with a desonide cream (Tridesonit). Prick-tests conducted later on confirmed the contact allergy to budesonide and Pulmicort spray. They were also positive for Tridesonit cream and triamcinolone acetonide. Repeated open application tests with a 17-butyrate hydrocortisone cream (Locoid) for three weeks remainded negative.. Our observation is original: allergic contact dermatitis to inhaled corticosteroids is rare, the clinical presentation mimicked angioedema although it was a delayed-type hypersensitivity, hypersensitivity was limited to group B corticosteroids and it was in fact a connubial contact dermatitis.

Topics: Administration, Inhalation; Angioedema; Asthma; Bronchodilator Agents; Budesonide; Child, Preschool; Dermatitis, Allergic Contact; Diagnosis, Differential; Humans; Male; Nebulizers and Vaporizers; Terbutaline

The reported prevalence of allergic contact dermatitis from topical corticosteroids in clinical populations, in the period 1993-2002, varied from 0.55 to 5.98%. This study is a retrospective analysis of 1153 individuals undergoing routine patch testing in an Occupational Dermatology Clinic in Melbourne, Australia. We report a rate of 0.52% for positive patch test reactions to 5 corticosteroids. Corticosteroids tested were betamethasone-17-valerate, budesonide, Diprosone cream (betamethasone diproprionate 0.05%) (Essex-Pharma, a division of Schering-Plough Pty Ltd, Sydney, Australia), tixocortol-21-pivalate and triamcinolone acetonide. Population characteristics were described using the MOAHL (M = percentage of males tested; O = occupational; A = atopics; H = patients with hand eczema; L = patients with leg ulcers or stasis eczema) index. Prescribing patterns, rate of referral and rate of relevant positive patch test reactions were characterized for the region. These results were compared to the rates of corticosteroid allergy and patch testing methodologies from published international studies. It was noted that many high-sensitization potential corticosteroids were not available in our region. Although a low percentage of leg ulcers and stasis dermatitis may be associated with a lower rate of corticosteroid allergy, this association may be confounded by regional factors such as prescribing habits and the local availability of corticosteroids. We conclude that the low rate of topical corticosteroid contact allergy reported by our clinic is associated with regional availability and prescribing practices and the scarcity of stasis dermatitis and leg ulcers in our clinic population.

Topics: Administration, Topical; Adult; Australia; Betamethasone; Betamethasone Valerate; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Occupational; Drug Utilization; Female; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Practice Patterns, Physicians'; Prevalence; Retrospective Studies; Triamcinolone Acetonide

Topics: Administration, Cutaneous; Animals; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Disease Models, Animal; Female; Glucocorticoids; Guinea Pigs; Patch Tests

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Budesonide; Child; Dermatitis, Allergic Contact; Diagnosis, Differential; Erythema; Humans; Male; Nose; Patch Tests; Rhinitis, Allergic, Seasonal

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Drug Interactions; Humans

Inhaled corticosteroids may cause various adverse effects ranging from irritation to severe anaphylactic reactions and systemic contact dermatitis. We report a 43-year-old woman who developed sore throat, swelling of the lips and oral cavity and dysphagia, 2 weeks after the use of budesonide spray (Budefat) for treatment of bronchial asthma. The symptoms occurred with a delay of 3-4 h after the treatment x2 daily. There were no immediate reactions on prick and intracutaneous testing with the commercial product used by the patient. However, marked pruritic infiltration developed within 24 h, progressing to coalescing eczematous lesions over the following 2 days. In addition, severe oedema of the right upper eyelid was observed. On patch testing, budesonide was strongly positive at day 2 and 3 in a concentration ranging from 1% to 10 p.p.m. (in petrolatum). Other corticosteroids of group A, B, C and D were completely negative. Repeated open application tests with amcinonide and triamcinolone acetonide cream on the ventral aspect of the upper arm were negative. Bronchial exposure to alternative sprays containing beclomethasone dipropionate (group D), fluticasone-17- propionate (D) and dexamethasone-21-isonicotinate (C) was well tolerated. In conclusion, this case is instructive, because the symptoms which developed after a short period of corticosteroid inhalation suggested a type I allergy. Testing proved a severe type IV contact allergy restricted to budesonide (group B), without cross-reactions to major corticosteroids of other groups.

Topics: Administration, Inhalation; Adult; Angioedema; Asthma; Bronchial Provocation Tests; Bronchodilator Agents; Budesonide; Deglutition Disorders; Dermatitis, Allergic Contact; Female; Humans; Skin Tests

Patch-test sensitization may be suspected when a flare-up is seen at a test site at least 10 days after the test application. We describe two patients allergic to budesonide who were only diagnosed at patch-test readings on day 10 and day 13, respectively. The patients were patch-tested to a standard series including two corticosteroid mixes and their three constituents in petrolatum, namely, budesonide, tixocortol pivalate, and hydrocortisone-17-butyrate, at differing concentrations. In both patients, positive reactions to the mixes were seen on day 6 or day 7, but positive reactions to the budesonide preparations at 0.1% and 0.002% were not seen on the first or second ordinary reading day, day 3 or 4, and day 6 or 7, but no positive reactions to both budesonide preparations were seen on day 10 and on day 13, respectively. Not all late patch-test reactions represent patch-test sensitization, at least not to budesonide.

Topics: Adult; Allergens; Budesonide; Dermatitis, Allergic Contact; Diagnosis, Differential; False Negative Reactions; Female; Humans; Male; Patch Tests

Topics: Administration, Topical; Adult; Aged; Budesonide; Cohort Studies; Cross Reactions; Dermatitis, Allergic Contact; Desonide; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Patch Tests; Sensitivity and Specificity

Topics: Allergens; Budesonide; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Drug Combinations; Ethanol; Female; Humans; Male; Mass Screening; Patch Tests; Petrolatum; Sensitivity and Specificity

Allergic contact dermatitis from topical corticosteroids is not uncommon. Budesonide has been included in the European standard series as a marker for corticosteroid allergy, though little is known of its cross-reactivity with other corticosteroids. Twelve patients previously positive to budesonide on patch testing were given further patch and intradermal tests to a range of corticosteroids. Six patients previously negative to budesonide on patch testing were used as a control group. Budesonide cross-reacts with hydrocortisone-21-sodium phosphate and triamcinolone acetonide. Patients positive to budesonide should therefore avoid hydrocortisone and triamcinolone acetonide. Patch testing, unfortunately, is an inaccurate method of determining cross-reactivity patterns among corticosteroids.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Case-Control Studies; Cross Reactions; Dermatitis, Allergic Contact; Glucocorticoids; Humans; Hydrocortisone; Methylprednisolone; Molecular Structure; Skin Tests; Triamcinolone Acetonide

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Chi-Square Distribution; Dermatitis, Allergic Contact; Humans; Hydrocortisone; Patch Tests; United Kingdom

Topics: Administration, Topical; Allergens; Anti-Inflammatory Agents; Austria; Budesonide; Dermatitis, Allergic Contact; Germany; Humans; Hydrocortisone; Patch Tests

Budesonide, a marker for corticosteroid allergy, is a 1:1 mixture of 2 diastereomers, the R and S, present in all commercial formulations. Budesonide is said to cross-react with group B substances through the R and S diastereomer and some group D substances only through the S diastereomer.. To investigate the cross-reactivity pattern between the R and S diastereomers and 4 potentially cross-reacting substances, 2 from group B and 2 from group D.. By patch testing 10 patients hypersensitive to budesonide with a serial dilution of budesonide, the R and S diastereomer, triamcinolone acetonide, amcinonide, prednicarbate, and hydrocortisone-17-butyrate.. Nine of 10 patients reacted to budesonide and the S diastereomer. Seven of 9 to the R diastereomer. Each of the 9 patients with S diastereomer allergy reacted to the group B and/or group D substances. Five patients reacted to triamcinolone acetonide, not to 1.0% but only to 0.0010% and 0.00010%.. The R and S diastereomers can induce positive patch test reactions in budesonide-hypersensitive individuals. The potential of budesonide to cross-react with substances from group B and D might be explained by the presence of the 2 diastereomers. When patch testing with triamcinolone acetonide, much lower concentrations than recommended should be used.

Topics: Allergens; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Humans; Patch Tests; Stereoisomerism

Patients using topically applied corticosteroids are at risk of developing allergic contact hypersensitivity.. To assess prevalence of allergic contact hypersensitivity reactions to inhaled or intranasal corticosteroids.. A prospective study of 30 adult patients using inhaled or intranasal corticosteroids for conditions such as allergic rhinitis was performed. We used epicutaneous patch testing to determine the prevalence of allergic contact hypersensitivity to corticosteroids and common additives (propylene glycol and benzalkonium chloride) in inhaled and nasal corticosteroid preparations in this population.. Of 30 patients, 4 (13%) had positive patch test results. 3 (10%) were allergic reactions and 1 (3%) was an irritant reaction. Half of the reactions were to a corticosteroid (budesonide) and half were to a common preservative in nasal preparations (benzalkonium chloride).. This study supports other clinical evidence that contact dermatitis/mucositis from inhaled or intranasal corticosteroid products can occur. The corticosteroids or added agents such as preservatives can be causative and may result in allergic or irritant reactions, which can be relevant to clinical symptoms.

Topics: Administration, Inhalation; Administration, Intranasal; Adult; Asthma; Benzalkonium Compounds; Bronchodilator Agents; Budesonide; Dermatitis, Allergic Contact; Female; Humans; Male; North Carolina; Patch Tests; Preservatives, Pharmaceutical; Prevalence; Rhinitis, Allergic, Perennial

This study investigated whether a corticosteroid mix containing tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate could detect contact allergy to corticosteroids. 2 corticosteroid mixes, 1 with a high (mix I) and 1 with a low (mix II) concentration and the 3 individual constituents, each at 2 concentrations, were inserted into the standard series of 16 participating clinics. Tests were read on day (D) 3 or 4. 5432 patients were tested, and 110 (2.0%) had positive reactions to at least 1 of the 8 test preparations. Of the 8 preparations, mix I identified most allergic patients, followed by mix II, budesonide 0.10%, budesonide 0.002%, and tixocortol pivalate, both concentrations (1.0 and 0.10%) tracing the same number. With the mixes, 53.2-59.6% of tixocortol pivalate allergy was missed. 47 patients were allergic to either concentration of tixocortol pivalate, 25% of these only to 1.0% and another 25% only to 0.10%. Testing with mix I and tixocortol pivalate 0.10% picked up 98/110, testing with tixocortol pivalate 1.0% and 0.10% and budesonide 0.10% picked up 105/110. 3379 patients were read on both D3 or D4 as well as on D7. Without a late reading (D7), up to 30% of contact allergy to corticosteroid markers was missed.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Combinations; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Male; Patch Tests

This study investigated the stability of tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate (Hc-17-B) when present in a mix with petrolatum and when the corticosteroids were kept separately in petrolatum. The concentrations chosen for the corticosteroids were the same as those used in a study within the European Environmental Contact Dermatitis Research Group (EECDRG), in which 2 corticosteroid mixes (1 with a high concentration and 1 with a low concentration) and the 3 individual constituents, each at 2 concentrations, were patch tested. Ethanolic solutions of each corticosteroid, as well as 2 mixtures of these 3 corticosteroids, were also made up at corresponding concentrations. The preparations were kept at room temperature, refrigerated, and deep frozen, and repeatedly for 1 year, investigations to check stability by high performance liquid chromatography were carried out. A decrease of < or =20% of the initial value at time 0 was used as the threshold for stability. The petrolatum preparations and the ethanolic solutions of budesonide and tixocortol pivalate were stable for at least the whole investigative period, irrespective of storage conditions, while Hc-17-B 1.0% in ethanol kept deep frozen was stable at least during the same period. The latter corticosteroid when kept at room temperature was stable for 3 months only.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Stability; Hydrocortisone; Patch Tests

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Budesonide; Child; Dermatitis, Allergic Contact; Drug Hypersensitivity; Glucocorticoids; Humans; Male; Patch Tests; Skin

Topics: Administration, Topical; Allergens; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Europe; Humans; Hydrocortisone; Patch Tests; Practice Guidelines as Topic; Reference Standards

Budesonide is advocated as a marker molecule for corticosteroid contact allergy. When patch testing corticosteroids, one must consider their sensitizing potential but also their anti-inflammatory properties, as well as the possibility of different time courses for such properties. The dose-response relationship for budesonide was therefore investigated with regard to dose, occlusion time, and reading time. 10 patients were patch tested with budesonide in ethanol in serial dilutions from 2.0% down to 0.0002% with occlusion times of 48, 24, and 5 h. Readings were on D2, D4, and D7. The 48-h occlusion picked up most positive reactors, 8/10. The D4 reading (48-h occlusion) detected most positive reactors, 8/10, and here 0.002% picked up most contact allergies. Late readings favoured high concentrations. The "edge effect" was noted for several concentrations at early readings. Due to the individual corticosteroid reactivity, the dose-response relationship and the time courses of the elicitation and the anti-inflammatory capacity, several features may be explained, i.e., that lower concentrations may detect budesonide allergy better at early readings, that patients with an "edge reaction" can have positive reactions to lower concentrations.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Drug Eruptions; Glucocorticoids; Humans; Patch Tests; Time Factors

The laser Doppler perfusion scanning technique is an objective, non-invasive assessment method that may be used to assess patch tests. The purpose of this paper is to focus on its clinical use in individuals with light skin, tested with non-pigmented test materials. A laser Doppler perfusion imager PIM 1.0 (LDPI) is used to study different set-ups of the instrument that may affect readings. These set-ups are studied through simulated light-absorbing patch tests. The results have served as a base for clinical experiments comparing visual and LDPI assessments of normal skin, irritant patch-test reactions, and more than 25,000 allergic patch-test assessments of reactions of different intensities and control patches. This paper reviews the clinical experiments to suggest a set-up of the LDPI for patch-test readings. Such a set-up makes it possible to compare intra- and inter-individual test results and to obtain meaningful assessment values among users. Some subject-related factors that may affect reading results are studied, and the effect of non-subject related factors on readings are considered. Use of the technique is illustrated by images of perfusion and a perfusion profile of a patch-test reaction followed over time.

Topics: Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Female; Humans; Laser-Doppler Flowmetry; Male; Patch Tests; Skin; Skin Pigmentation; Skin Temperature; Time Factors

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Budesonide; Child; Child, Preschool; Dermatitis, Allergic Contact; Female; Glucocorticoids; Humans; Male; Middle Aged; Patch Tests; Prednisolone

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Asthma; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Humans; Hydrocortisone; Patch Tests; Rhinitis

Topics: Adult; Bronchodilator Agents; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Atopic; Diagnosis, Differential; Female; Humans; Nebulizers and Vaporizers; Patch Tests; Recurrence

Patch-test technique for budesonide needs improvement. 20 subjects with positive or questionable patch-test responses to budesonide were retested for 3 to 96 h (4 days [D]) with polyester patches coated with budesonide in serial doses (150 to 0.074 microg/cm2). Multiple readings were taken visually and with a laser Doppler perfusion imaging technique up to 264 h (day [D]11). Additionally, all subjects were tested with 0.1% budesonide in petrolatum in Finn Chambers for 48 h (2D) with readings taken at 72 (D3), 96 (D4) and 168 h (D7). Different dose levels and application times affected unpredictably highest assessments of reactions. No clear suppression of reactivity was observed at high doses. Time points of highest assessments of reactions varied between subjects but were generally the same for each subject with both reading methods regardless of dose levels or application times. Positive and negative subjects during the study were easily distinguished with all serial doses, regardless of assessment technique. At 2.0 microg/cm2, the lowest dose level tested on all subjects, longer applications than 24 h (1D) were required to detect all positive subjects. 48-h (2-D) applications required 2 readings, optimally at 96 (D4) and 216 h (D9). The only test technique with Finn Chambers used here did not make such distinction possible.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Budesonide; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Female; Humans; Laser-Doppler Flowmetry; Male; Middle Aged; Patch Tests; Severity of Illness Index; Single-Blind Method; Skin; Time Factors

Tixocortol pivalate is an established marker to topical corticosteroid allergy. The prevalence of tixocortol pivalate hypersensitivity is well established in Europe, where exposure to this corticosteroid as a therapeutic agent varies. In the United States, tixocortol pivalate is not commercially available and the prevalence of hypersensitivity to it is unknown.. We investigated the prevalence of tixocortol pivalate hypersensitivity in our patch-tested population. We further characterized these patients by clinical background, other contact allergens, and the reactivity to other corticosteroids.. Tixocortol pivalate has been incorporated in our standard 1-52 patch test series since November 1992. We reviewed the histories and patch test results in all patients tested with the standard 1-52 series from November 1992 to December 1996.. Of 1536 patch-tested patients, 45 had hypersensitivity to tixocortol pivalate. Dermatitis involving the face was the most common (14 patients). Of the 45 patients, 40 had another allergen identified on patch testing. Eighteen patients underwent further patch testing to an extended corticosteroid panel, and 14 had sensitivity to another steroid agent.. The 2.9% prevalence of tixocortol pivalate hypersensitivity in our patch test population is within the range reported in Europe. Patients with tixocortol pivalate hypersensitivity tend to have other contact allergens on patch testing. Predisposing factors to tixocortol pivalate hypersensitivity include facial dermatitis and sensitivity to other contact allergens.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Allergens; Anti-Allergic Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Europe; Facial Dermatoses; Female; Humans; Hydrocortisone; Male; Middle Aged; Minnesota; Neomycin; Patch Tests; Prevalence; Risk Factors; Triamcinolone

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Glucocorticoids; Humans; Patch Tests

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Female; Glucocorticoids; Hand Dermatoses; Humans; Methylprednisolone; Patch Tests

Whilst patch testing with corticosteroids in ethanol is more sensitive than either petrolatum or the cream formulation, the frequency of false-negative reactions is not known. We have compared patch testing with corticosteroid at 1% in ethanol with intradermal (i.d.) tests using 1 mg corticosteroid suspended in normal saline. Patch tests with tixocortol pivalate and budesonide detected all patients allergic to hydrocortisone and budesonide, respectively. For other corticosteroids, the use of ethanol as a vehicle resulted in both false-positive and false-negative reactions. In particular, patch tests with hydrocortisone-17-butyrate missed 30% of all positive reactions detected by i.d. testing. There may be a case for advising the avoidance of this steroid in all patients who are positive on patch testing to tixocortol pivalate and budesonide.

Topics: Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Ethanol; Humans; Hydrocortisone; Intradermal Tests; Patch Tests; Pregnenediones; Sensitivity and Specificity; Sodium Chloride; Suspensions; United Kingdom

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Female; Glucocorticoids; Humans; Nasal Septum; Patch Tests; Rhinitis, Vasomotor

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Diagnosis, Differential; Drug Eruptions; Erythema Multiforme; Female; Glucocorticoids; Humans; Patch Tests; Pregnenediones

The correct concentration and vehicle for patch testing with corticosteroids is in many instances not known. The results of this study suggest that 1% in ethanol should be the initial choice, unless it can be shown that petrolatum as a vehicle is as sensitive (tixocortol pivalate and budesonide). We could find no evidence for the anti-inflammatory effects of corticosteroids inhibiting the patch test at higher concentrations. Using ethanol as the vehicle resulted in reactions developing at earlier time points than with petrolatum.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dermatologic Agents; Drug Eruptions; Ethanol; Humans; Hydrocortisone; Patch Tests; Petrolatum; Pharmaceutical Vehicles; Pregnenediones

Mometasone furoate is a new corticosteroid, synthesized to have an improved ratio of anti-inflammatory potential to adverse effects. The guinea pig maximization test was used to determine the sensitizing capacity of mometasone furoate, and also to investigate cross-reaction patterns in animals sensitized to tixocortol pivalate and budesonide, respectively. Tixocortol pivalate was shown to be a sensitizer in the guinea pig, but cross-reactions to other tested corticosteroids were not observed. Furthermore, no sensitizing capacity could be demonstrated for budesonide or mometasone furoate.

Topics: Administration, Cutaneous; Administration, Topical; Animals; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Female; Glucocorticoids; Guinea Pigs; Hydrocortisone; Immunization; Injections, Intradermal; Mometasone Furoate; Patch Tests; Prednisolone; Pregnadienediols; Pregnenediones; Time Factors; Triamcinolone Acetonide

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Female; Glucocorticoids; Humans; Middle Aged; Ointments; Pregnenediones

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Female; Glucocorticoids; Humans; Pregnenediones; Psoriasis

5 cases of allergic contact dermatitis due to budesonide are described. We studied the antigen determinant structures in these cases by applying patch tests with several substances related to budesonide. 2 cases showed cross-reactions to both amcinonide and prednisolone acetate. The antigen determinant structure is also discussed.

Topics: Adult; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Female; Humans; Male; Prednisolone; Pregnenediones; Triamcinolone

Topics: Administration, Intranasal; Adult; Aerosols; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Facial Dermatoses; Female; Glucocorticoids; Humans; Pregnenediones

We describe a case of contact allergic sensitization to budesonide in a nasal spray used in the treatment of allergic rhinitis. No cross-sensitivity to other topical corticosteroids was found.

Topics: Adult; Aerosols; Budesonide; Dermatitis, Allergic Contact; Female; Humans; Nasal Decongestants; Pregnenediones

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Eruptions; Glucocorticoids; Humans; Male; Pregnenediones; Rhinitis

Topical corticosteroids are increasingly recognized as relatively common contact sensitizers. Between July 1988 and December 1991 2687 patients undergoing routine patch testing were also tested with tixocortol pivalate (TP). Over the same time period 528 patients were selected for testing with a series of 18 steroids. One-hundred and thirty-one cases (4.9%) of corticosteroid hypersensitivity were detected and 119 (90.8%) of these cases were positive to TP. Thirty-seven patients reacted to one or more steroids in the steroid series, the most frequent sensitizers being hydrocortisone, budesonide (3.6%) and hydrocortisone 17-butyrate (2.5%). Of these 37 cases, 20 (54%) reacted to more than one steroid simultaneously, but the patterns of cross-reaction were not consistent with previously suggested groupings. Screening for steroid allergy should be performed as part of standard patch testing. The value of TP as a marker of corticosteroid hypersensitivity is reinforced by this study, but no satisfactory marker was found for the 9.2% of cases not detected by TP. There remains a need for further markers of corticosteroid hypersensitivity. A prevalence of 4.9% of corticosteroid allergy amongst our patients suggests that the frequency of this finding is generally underestimated.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Budesonide; Child; Dermatitis, Allergic Contact; Female; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Pregnenediones; Prevalence