Anaphylaxis to 6-α-methylprednisolone in an eight-year-old child☆,☆☆,★

CASE REPORT

An 8-year-old boy with mild cat dander–induced asthma consulted us because he had had an adverse reaction to Urbason (6-α-methylprednisolone hemisuccinate, monosodium phosphate, disodium phosphate, and distilled water). He had been treated with this drug before and had shown good tolerance. No other diseases were reported.

After the boy spent the night at the house of a friend who kept several cats, cough and wheezing developed. He was seen at our hospital’s emergency department where he was

METHODS

Skin prick tests with Urbason, 10 mg/ml, and pure 6-α-methylprednisolone dissolved in water at a concentration of 10 mg/ml were performed. Skin prick tests with additives at 10 mg/ml and several other corticosteroids (hydrocortisone at 10 mg/ml and 50 mg/ml; prednisone, prednisolone, betamethasone, dexamethasone, and deflazacort at 10 mg/ml and 20 mg/ml; and budesonide at 0.5 mg/ml) were performed.

Epicutaneous patch tests with hydrocortisone, methylprednisolone, budesonide, tixocortol, and

RESULTS

Results of skin prick tests with both Urbason (wheal, 6 × 6 mm; flare, 10 × 13 mm) and pure 6-α-methylprednisolone (wheal, 6 × 7 mm; flare, 12 × 13 mm) were positive. Tests were repeated twice with same result (histamine control wheal, 5 × 5 mm; flare, 11 × 10 mm; saline solution, 0 mm). Skin prick tests were also performed on 10 atopic patients and on 10 nonatopic control subjects, and in both cases results were negative.

Results of skin prick tests performed on our patient with the other

DISCUSSION

Cases of allergic and pseudoallergic reactions resulting from systemic corticosteroid therapy have been reported in the literature.1, 2, 4, 5, 6, 7 Severe allergic reactions caused by corticosteroids, however, have not been described in childhood.

We report on an 8-year-old boy who had an anaphylactic reaction to 6-α-methylprednisolone, which he had used and tolerated to treat his asthma before. We did not perform a challenge test with 6-α-methylprednisolone because of the risk of a new

Acknowledgements

We thank Drs. Elena de Terán Bleiberg and Javier Gómez Aguirre for their assistance in writing the manuscript. We also thank Dr. Ana Carmen Gil-Adrados for her useful comments.