Hypersensitivity Reaction to Corticosteroids in a Patient with Atopic Dermatitis
Keywords:
antiinflammatories, immunomodulators, hypersensitivity reactions, sensitization.Abstract
Introduction: The use of corticosteroids is common in clinical practice, due to their antiinflammatory and immunomodulatory effects; however, these can also provoke, although rarely, hypersensitivity reactions.
Objective: To evaluate a patient with contact hypersensitivity induced by the systemic use of prednisolone.
Case presentation: The case is presented of a young female patient who, due to the frequent use of topical steroids because of her history of atopic dermatitis, suffered sensitization to these drugs and, after treatment with prednisolone (oral way), skin lesions appeared, different from those of her baseline disease. Interrogation and immediate skin tests were performed, with reading at 15 minutes, as well as controlled exposure and epicutaneous tests with reading at 48 and 72 hours. Dilutions with four types of commonly used corticosteroids were used. Immediate and controlled exposure skin tests were negative. The epicutaneous test was positive in both readings with the use of prednisolone.
Conclusions: Clinical manifestations of a delayed or cellular hypersensitivity reaction to corticosteroids are usually associated with topical exposure to the drug; however, on rare occasions they may appear after systemic exposure, prior to sensitization through the skin. Diagnostic confirmation by means of skin tests and the search for therapeutic alternatives avoid completely depriving the patient of these drugs. The results allowed affirming that the patient is a carrier of systemically induced delayed hypersensitivity to prednisolone.
Downloads
References
Durán M, Pinochet V, Aguayo M, Azócar C, Yáñez J. Hipersensibilidad a corticoides y manejo en asma severa. A propósito de un caso. Rev Chil Enferm Respir. 2018 [acceso 20/08/2022];34(1). Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0717-73482018000100048
Vigand S, Overgaard R, Mortz Ch. Prevalence of contact allergy to corticosteroids in a Danish patient population. Contact Dermat. 2022 [acceso 10/01/2023];87(3):273-9 Disponible en: https://pubmed.ncbi.nlm.nih.gov/35460519/
Voltolini S, Fumagalli F. Delayed corticosteroid hypersensitivity: a clinical management proposal. eurann allergy clin immunol. 2021 [acceso 02/01/2023];53(4):171-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32729318/
Silva M, Ivanchuk A, Mie N, Lazzarini R. Allergic contact dermatitis to corticosteroids: experience of a referral clinic from 2014 to 2018. An Bras Dermatol. 2022 [acceso 25/08/2022];97(3):379-82. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133237/
Hertzman R, Deshpande P, White K, Gangula R, Abha A, Ram R, et al. Single-cell immunopathology of systemic contact allergy associated with corticosteroids. J Dermatol Sci. 2022 [acceso 11/11/2022];105(2):137-40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920767/
Coopman S, Degreef H, Dooms-Goossens A. Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids. Br J Dermatol. 1989 [acceso 18/01/2023];121:27-34. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2133.1989.tb01396.x
Baeck M, Chemelle J, Goossens A, Nicolas J, Terreux R. Corticosteroid cross-reactivity: clinical and molecular modelling tools. Allergy. 2011;66:1367-74. DOI: https://doi.org/10.1111/j.1398-9995.2011.02666.x
Chiriac A, Bousquet J, Demoly P. In Vivo Methods for the Study and Diagnosis of Allergy. En: Wesley A, Holgate S, O’Hehir R, Broide D, Bacharier L, Khurana G. Middleton’s Allergy Principles and Practice. Ninth Edition. EUA: Booksmedicos. org; 2020. p.1097-1109.
Vigand S. The benefit of late patch test readings in corticosteroid allergy. Cont derma. 2022 [acceso 29/10/2022];87(5):466-8. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/cod.14197
Ansotegui I, Melioli G, Canonica G, Caraballo L, Villa E, Ebisawa M, et al. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J. 2020 [acceso: 08/02/2023];13(2):100080. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044795/
Downloads
Published
How to Cite
Issue
Section
License
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
