Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.
J Investig Allergol Clin Immunol. 2010;20(6):529-32.
We describe 5 cases of immediate-type reactions to systemic corticosteroids observed during the last 2 decades in boys aged 2, 4, 8, 9, and 10 years. Symptoms ranged from generalized urticaria and angioedema to anaphylactic shock immediately after administration. Oral betamethasone was implicated in 2 cases, oral prednisolone in 2 cases, and intravenous prednisolone in 1 case. The parents of patient 5 refused the skin tests. The remaining patients underwent skin prick tests with the following undiluted corticosteroids: parenteral prednisolone, oral prednisolone, parenteral methylprednisolone, parenteral dexamethasone, parenteral hydrocortisone, and oral betamethasone. If the results were negative, intradermal tests were performed with the same drugs at increasing concentrations. Skin test results were positive for all suspect corticosteroids, thus indicating an immunoglobulin E-mediated mechanism. Two patients had positive skin test results to other corticosteroids, suggesting cross-reactivity. An oral challenge test was performed with deflazacort in 4 cases and with betamethasone in 1 case; the results were negative.
我们描述了 5 例在过去 20 年间观察到的全身性皮质类固醇即刻型反应病例，涉及年龄分别为 2 岁、4 岁、8 岁、9 岁和 10 岁的男孩。症状范围从全身性荨麻疹和血管性水肿到给药后即刻发生的过敏性休克。2 例涉及口服倍他米松，2 例涉及口服泼尼松龙，1 例涉及静脉注射泼尼松龙。第 5 例患儿的家长拒绝进行皮肤测试。其余患者进行了皮肤点刺试验，所用未稀释皮质类固醇包括：静脉注射用泼尼松龙、口服泼尼松龙、静脉注射用甲泼尼龙、静脉注射用地塞米松、静脉注射用氢化可的松和口服倍他米松。如果结果为阴性，则用相同药物进行皮内试验，浓度逐渐增加。所有可疑皮质类固醇的皮肤试验结果均为阳性，表明存在免疫球蛋白 E 介导的机制。2 例患者对其他皮质类固醇的皮肤试验结果呈阳性，提示存在交叉反应。对 4 例患者用地夫可特进行了口服激发试验，对 1 例患者用倍他米松进行了口服激发试验，结果均为阴性。
