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The Journal of the American Board of Family Practice 18:143-146 (2005)
© 2005 American Board of Family Practice

Brief Report

Anaphylaxis Induced by Glucocorticoids

Stephan M. Erdmann, MD, Faris Abuzahra, MD, Hans F. Merk, MD, Anja Schroeder, MD and Jens M. Baron, MD

From the Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany

Correspondence: Address correspondence to: Stephan M. Erdmann, Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany (e-mail: serdmann{at}ukaachen.de)

Abstract

Glucocorticoids are frequently used to treat allergic reactions. Therefore, allergic reactions to systemic glucocorticoids in particular are considered most unlikely and are not well known. We report on a 23-year-old woman with atopic dermatitis who had an anaphylactic reaction after oral administration of prednisolone. On treatment with epinephrine, antihistamines and volume symptoms resolved. Skin testing with a panel of glucocorticoids showed immediate type reactions to prednisolone, prednisolone hydrogen succinate, prednisone, and betamethasone dihydrogen phosphate. In challenge testing the patient tolerated methyl prednisolone and dexamethasone. There is increasing evidence that true allergic immediate type reactions to glucocorticoids exist. The severity of the reaction can vary from a rash to anaphylaxis. However, a patient sensitized to one or a group of glucocorticoids does not have to refrain from all types of glucocorticoids. Careful challenge testing is by far the best way to select glucocorticoids that are safe for future treatment. Clinicians should be aware that allergic reactions to glucocorticoids can occur and that worsening of symptoms does not always mean treatment failure.






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Copyright © 2005 by the American Board of Family Medicine.