pulmicort and Drug-Hypersensitivity

Autoimmune hepatitis (AIH) is a chronic, progressive hepatitis of uncertain cause which has fluctuating activity characterized by periods of flares and remissions. Initial placebo-controlled trials carried out in the 1970s demonstrated that immunosuppression with steroids was extremely effective in reducing flares and progression of disease. The late 1980s-1990s could be described as the 'Dark Ages' of AIH treatment research. Very few clinical studies were performed during this time, although it became increasingly apparent that not all patients tolerated or responded to traditional immunosuppression, and that not all patients were easy to diagnose because of overlapping features with other autoimmune conditions. Fortunately, clinical research in the treatment of AIH has experienced a renaissance in the 21st century.. This review highlights some of the more important recent discoveries, including the creation of the clinically useful short form of the autoimmune hepatitis diagnostic scoring system; accumulation of data supporting the use of mycophenolate and tacrolimus as second-line treatment; and the recent completion of the largest, double-blind, placebo-controlled trial of AIH treatment to date, comparing budesonide to prednisone.. These new findings are pertinent to the everyday clinical management of patients with AIH.

Topics: Azathioprine; Budesonide; Drug Hypersensitivity; Hepatitis, Autoimmune; Humans; Immunosuppressive Agents; Mycophenolic Acid; Purine-Pyrimidine Metabolism, Inborn Errors; Tacrolimus

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

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

The importance of the reactivity at the edges of corticosteroid patch tests is unknown.. To study the clinical importance of edge reactivity in budesonide patch tests.. Ten subjects previously positive for budesonide patch tests were retested with 0.1% budesonide in Finn Chambers((R)) and with budesonide-printed polyester squares in serial doses (150-0.074 microg/cm(2)). Six exposure periods were used for each polyester square dose (3 h to 4 days). Tests were followed up to 11 days. Doubtful or weakly visible reactivity at the test edges was assessed additionally by test perfusion assessments.. Nine of 10 subjects reacted with some edge reactivity and later exhibited positive reactions. Perfusion assessments helped to confirm early edge reactivity. Some allergic subjects showed edge reactivity only at high doses, while longer applications were required for weaker doses.. Edge reactivity may be an indicator of a strong suppressed test response.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Dose-Response Relationship, Immunologic; Drug Hypersensitivity; Female; Genetic Variation; Glucocorticoids; Humans; Laser-Doppler Flowmetry; Male; Middle Aged; Patch Tests; Skin; Time Factors

In dermatological practice, allergy to topical corticosteroids used to treat eczema is a recognized and common event. The typical presentation is of an eczema which fails to improve or deteriorates with treatment. Topical corticosteroids are also used to treat mucosal disease. This study assesses allergy to inhaled corticosteroids in asthmatics. In the patient group selected, there was no evidence of relevant corticosteroid allergy.

Topics: Administration, Inhalation; Administration, Topical; Adult; Aged; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Budesonide; Drug Hypersensitivity; Female; Glucocorticoids; Humans; Immunoglobulin G; Intradermal Tests; Male; Methylprednisolone; Middle Aged; Pregnenediones

Topics: Administration, Inhalation; Asthma; Bronchodilator Agents; Budesonide; Diagnosis, Differential; Drug Hypersensitivity; Edema; Female; Humans; Hypersensitivity, Immediate; Lip Diseases; Middle Aged

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

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: Anti-Inflammatory Agents; Budesonide; Drug Hypersensitivity; Humans; Risk Factors

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

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

Topics: Administration, Oral; Adult; Adverse Drug Reaction Reporting Systems; Anti-Inflammatory Agents, Non-Steroidal; Budesonide; Crohn Disease; Drug Hypersensitivity; Female; Glucocorticoids; Humans; Mesalamine

The inflammatory cell infiltrate in bronchial biopsies of 12 aspirin-sensitive asthmatic (ASA) subjects and eight non-aspirin-sensitive (non-ASA) control subjects have been compared. Biopsies were taken from a right middle or lower lobe segmental carina using fiberoptic bronchoscopy. The biopsies were snap-frozen in OCT, and sections 5 microns thick were doubled immunostained using a rabbit polyclonal antibody to the enzyme 5-lipoxygenase (5-LO) and with a monoclonal antibody to neutrophils (NP57), macrophages (EMB11), and total (BMK13) and activated eosinophils (EG2), mast cells (AA1), and T-lymphocytes (anti-CD3). There was no significant difference in the total numbers of cells staining for 5-LO between the two groups of subjects. As a percentage of total 5-LO cells, there were significantly more mast cells (12.9 +/- 3.8% versus 3.4 +/- 3.1%; p = 0.039) and total eosinophils (34.7 +/- 9.4% versus 11.1 +/- 3.8%; p = 0.044) and significantly fewer macrophages (23.3 +/- 6.1% versus 39.8% +/- 5.3; p = 0.041) in the bronchial biopsies from ASA subjects as compared with non-ASA patients. The numbers of neutrophils, T-lymphocytes, and activated eosinophils were similar for the two groups. The increased numbers of eosinophils and mast cells identified in the bronchial tissue from aspirin-sensitive asthmatic subjects may be the source of the enhanced cysteinyl leukotriene production observed in these subjects.

Topics: Administration, Inhalation; Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Adult; Animals; Anti-Inflammatory Agents; Aspirin; Asthma; Biopsy; Bronchi; Bronchodilator Agents; Bronchoscopy; Budesonide; Cell Count; Coloring Agents; Data Interpretation, Statistical; Drug Hypersensitivity; Eosinophils; Female; Glucocorticoids; Humans; Immunohistochemistry; Inflammation; Macrophages; Male; Middle Aged; Neutrophils; Prednisolone; Pregnenediones; Rabbits; T-Lymphocytes

Corticosteroid cross-reactions have been classified into four well-defined groups. A previous study of patch test reactions to other corticosteroids in patients allergic to hydrocortisone failed to conform to these groups. It was suggested that substitution at the C6 and C9 positions of the corticosteroid was the most important determinant of a further reaction.. Our aim was to analyze multiple positive patch tests to corticosteroids in patients sensitized to budesonide to confirm our earlier findings.. Forty-six patients with positive patch tests to budesonide were patch-tested to 17 other topical corticosteroids. The results were examined by a generalized linear model and a chi-square test.. Substitution of the corticosteroid at the C6 and C9 positions significantly reduced the number of reactions. A different substitution at the C16 and C17 positions was less important, and that at the C21 position was of no significance.. Patients sensitized to budesonide are most likely to react to other non-C6 and non-C9 substituted corticosteroids.

Topics: Adrenal Cortex Hormones; Analysis of Variance; Back; Binomial Distribution; Budesonide; Chi-Square Distribution; Confidence Intervals; Drug Hypersensitivity; Glucocorticoids; Humans; Patch Tests; Pregnenediones; Structure-Activity Relationship; Time Factors

Topics: Aerosols; Bronchodilator Agents; Budesonide; Drug Hypersensitivity; Glucocorticoids; Humans; Male; Patch Tests; Pregnenediones

Topics: Adult; Aerosols; Bronchodilator Agents; Budesonide; Dermatitis, Contact; Drug Hypersensitivity; Female; Humans; Nasal Mucosa; Nasopharyngitis; Pregnenediones; Rhinitis; Skin Tests