Venturini M, Lobera T, del Pozo M D, González I, Blasco A
Allergology Unit, Fundación Hospital de Calahorra, La Rioja, Spain.
J Investig Allergol Clin Immunol. 2006;16(1):51-6.
In comparison with the extremely frequent use of corticosteroids in different diseases, immediate allergic reactions remain uncommon. In addition to the steroid molecule, the causative agent of these reactions can be an excipient.
We report seven cases of immediate reactions induced by different preparations of corticosteroids. Skin tests with the suspected steroid and excipients were carried out. In patients with negative skin tests, oral or parenteral challenges were performed with the drug and the excipients involved. Challenge tests with at least two other corticosteroids belonging to another or even the same group of the Coopman classification were carried out.
Of the 7 patients, six had positive skin tests with the suspected preparation of corticoid: three cases with methylprednisolone acetate, two cases with carboxymethylcellulose and one case with the complete triamcinolone preparation. Only in one case did we have to challenge with the suspected steroid preparation to confirm the diagnosis. All challenge tests with other corticosteroids belonging to another or to the same group of the Coopman classification were negative.
The reactions were caused by the steroid molecule (Triamcinolone or methylprednisolone succinate) in four patients, by an excipient (carboxymethylcellulose) in another two patients and we could not identify the sensitized molecule in one patient. We did not demonstrate cross-reactivity between different corticosteroids.
与皮质类固醇在不同疾病中的广泛使用相比，即刻过敏反应仍然不常见。除类固醇分子外，这些反应的致病因素可能是辅料。
我们报告了7例由不同皮质类固醇制剂引起的即刻反应病例。对可疑类固醇和辅料进行了皮肤试验。皮肤试验阴性的患者，对相关药物和辅料进行口服或注射激发试验。对至少另外两种属于库普曼分类中另一组甚至同一组的皮质类固醇进行激发试验。
7例患者中，6例对可疑皮质类固醇制剂皮肤试验呈阳性：3例对醋酸甲泼尼龙呈阳性，2例对羧甲基纤维素呈阳性，1例对曲安奈德完整制剂呈阳性。仅1例患者我们必须用可疑类固醇制剂进行激发试验以确诊。所有对属于库普曼分类中另一组或同一组的其他皮质类固醇进行的激发试验均为阴性。
4例患者的反应由类固醇分子（曲安奈德或琥珀酸甲泼尼龙）引起，另外2例患者的反应由辅料（羧甲基纤维素）引起，1例患者中我们无法确定致敏分子。我们未证明不同皮质类固醇之间存在交叉反应。
