Research Unit for Allergic Diseases, Carlos Haya Hospital, Málaga, Spain.
Allergy. 2010 Nov;65(11):1376-80. doi: 10.1111/j.1398-9995.2010.02386.x. Epub 2010 Jun 16.
Allergic reactions to systemically administered corticosteroids seem to be infrequent considering their extensive use. The aim of the study was to evaluate the IgE response in patients with immediate allergic reactions to methylprednisolone (MP).
Four subjects who developed immediate reactions after MP administration and ten controls with good tolerance to MP administration were evaluated. Skin prick and intradermal testing were done using MP, hydrocortisone (HC), and dexamethasone (DX). If negative, a drug provocation test (DPT) was done to confirm the diagnosis and assess cross-reactivity. The in vitro IgE response was evaluated by the basophil activation test (BAT) and ImmunoCAP.
Three patients were diagnosed by the presence of a positive skin test in the immediate reading with MP, two by prick and one by intradermal testing, and one patient was skin test negative and diagnosed by DPT. All four patients had good tolerance to HC and DX. The BAT was positive for just MP in those patients with positive skin tests, with all patients being negative for HC and DX. Two patients were also ImmunoCAP positive to MP.
This study confirms the existence of immediate allergic reactions to MP and that some are mediated by specific IgE antibodies. Skin testing, ImmunoCAP and the BAT are useful to confirm the diagnosis.
考虑到皮质类固醇的广泛应用，全身性给予皮质类固醇后发生过敏反应似乎并不常见。本研究旨在评估对甲基强的松龙（MP）发生即刻过敏反应的患者的 IgE 反应。
评估了 4 名在 MP 给药后发生即刻反应的患者和 10 名对 MP 给药具有良好耐受性的对照者。使用 MP、氢化可的松（HC）和地塞米松（DX）进行皮肤点刺和皮内试验。如果为阴性，则进行药物激发试验（DPT）以确认诊断并评估交叉反应。通过嗜碱性粒细胞活化试验（BAT）和 ImmunoCAP 评估体外 IgE 反应。
3 名患者通过即刻读取时 MP 的阳性皮肤试验诊断，2 名通过点刺试验，1 名通过皮内试验，1 名患者皮肤试验阴性，通过 DPT 诊断。所有 4 名患者对 HC 和 DX 均具有良好的耐受性。对皮肤试验阳性的患者，BAT 仅对 MP 呈阳性，而对 HC 和 DX 均为阴性。2 名患者也对 MP 进行了 ImmunoCAP 阳性检测。
本研究证实了对 MP 存在即刻过敏反应，其中一些是由特异性 IgE 抗体介导的。皮肤试验、ImmunoCAP 和 BAT 有助于确认诊断。
