Allergy Department, Catholic University, Policlinico 'A. Gemelli,' Largo F. Vito, 1-00168 Rome, Italy.
Eur J Endocrinol. 2011 Jan;164(1):139-40. doi: 10.1530/EJE-10-0863. Epub 2010 Oct 20.
We present the case of a woman with 'empty sella syndrome' who experienced generalized urticaria after the administration of sodium succinate hydrocortisone in two episodes.
The patient underwent an allergological evaluation (prick, intradermal, and patch tests) with hydrocortisone sodium succinate, hydrocortisone acetate, hydrocortisone, hydrocortisone sodium phosphate, methylprednisolone hemisuccinate, methylprednisolone, and preservatives held in the formulation of sodium succinate hydrocortisone (sodium phosphate and methyl-p-oxybenzoate). The basophil activation test (BAT) was also performed with hydrocortisone. The single-blind i.m. challenge test was performed with hydrocortisone sodium phosphate in 4 days.
Skin test with hydrocortisone sodium succinate and methylprednisolone hemisuccinate was positive. On the contrary, allergological tests performed with other formulations of the same steroids and preservatives were negative. These results showed an immediate-type allergy to succinate ester. BAT was not helpful to improve our diagnostic work-up because our patient was a 'nonresponder.' Therefore, the patient underwent successfully to a challenge test with hydrocortisone sodium phosphate.
Patients with succinate ester allergy can tolerate alternative corticosteroids without ester.
我们报告了一例“空泡蝶鞍综合征”女性患者，她在两例中分别接受琥珀酸钠氢化可的松治疗后出现全身性荨麻疹。
对患者进行了皮质醇琥珀酸钠、醋酸氢化可的松、氢化可的松、磷酸氢化可的松钠、甲泼尼龙琥珀酸钠、甲泼尼龙和琥珀酸钠氢化可的松制剂中所含防腐剂（磷酸钠和对羟基苯甲酸甲酯）的过敏评估（划痕、皮内和斑贴试验）。还对氢化可的松进行了嗜碱性粒细胞活化试验（BAT）。在 4 天内对磷酸氢化可的松钠进行了单次盲肌内挑战试验。
皮质醇琥珀酸钠和甲泼尼龙琥珀酸钠的皮肤试验呈阳性。相反，对其他相同类固醇和防腐剂制剂进行的过敏试验为阴性。这些结果表明对琥珀酸酯呈即刻型过敏。BAT 对提高我们的诊断工作没有帮助，因为我们的患者是“无反应者”。因此，患者成功地接受了磷酸氢化可的松钠的挑战试验。
对琥珀酸酯过敏的患者可以耐受不含酯的替代皮质类固醇。
