Uter Wolfgang, de Pádua Cristiane Menezes, Pfahlberg Annette, Nink Katrin, Schnuch Axel, Lessmann Holger
Institute for Medical Information Technology, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany.
J Dtsch Dermatol Ges. 2009 Jan;7(1):34-41, 34-42. doi: 10.1111/j.1610-0387.2008.06844.x. Epub 2008 Aug 28.
Contact allergy (CA) to topical corticosteroids (CS) is relatively rare; however, current data from Germany are not available. Furthermore, valid risk assessment needs to take into account of the actual exposure to CS in the population.
The reaction profile of 9 CS included in a "CS test battery" of the German Contact Dermatitis Research Group (DKG) in patients seen in German clinics belonging to the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) between 01/1995 and 12/2004 was analyzed. Applying the "Clinical Epidemiology/Drug Utilization Research" approach, annual incidences of CA to CS in Germany were extrapolated. These estimates were used as numerator for a relative incidence (RI) estimate which used exposure in terms of "defined daily doses" (DDD) to the respective CS as denominator, the latter information collected by the AOK Research Institute (WIdO).
On average, 7.4% of all patients were patch tested with the CS series, mostly yielding < 1% positive reactions. Exceptions included hydrocortisone 17-butyrate (1.5%), amcinonide (1.6%) and budesonide (2.6%). With a RI of 10.7, 23.6 and 4.9 per 100,000 DDD, respectively, the three CS mentioned classify as moderate topical drug allergens. Clobetasol 17-propionate and triamcinolone acetonide both yielded a RI of 1.4/100,000 DDD, indicating low sensitization risk. For hydrocortisone, betamethasone, prednisolone and dexamethasone (RI < 1/100,000 DDD) the risk of sensitization appears minute.
The results support and extend previous evidence on the CA risk of CS, adding to a therapeutic index and risk assessment.
对局部用皮质类固醇（CS）的接触性过敏（CA）相对少见；然而，目前尚无来自德国的数据。此外，有效的风险评估需要考虑人群中CS的实际暴露情况。
分析了德国接触性皮炎研究组（DKG）“CS测试组合”中的9种CS在1995年1月至2004年12月期间于德国皮肤科信息网络（IVDK；http://www.ivdk.org）所属诊所就诊患者中的反应情况。采用“临床流行病学/药物利用研究”方法，推断德国CA对CS的年发病率。这些估计值用作相对发病率（RI）估计的分子，该估计以“限定日剂量”（DDD）表示的对各CS的暴露量作为分母，后者信息由AOK研究所（WIdO）收集。
平均而言，所有患者中有7.4%接受了CS系列的斑贴试验，大多产生<1%的阳性反应。例外情况包括丁酸氢化可的松（1.5%）、安西奈德（1.6%）和布地奈德（2.6%）。上述三种CS的RI分别为每100,000 DDD 10.7、23.6和4.9，属于中度局部药物过敏原。丙酸氯倍他索和曲安奈德的RI均为1.4/100,000 DDD，表明致敏风险较低。对于氢化可的松、倍他米松、泼尼松龙和地塞米松（RI<1/100,000 DDD），致敏风险似乎极小。
结果支持并扩展了先前关于CS的CA风险的证据，补充了治疗指数和风险评估。
