Immunology Department, Auckland City Hospital, Auckland, New Zealand.
Clin Exp Allergy. 2015 Mar;45(3):669-76. doi: 10.1111/cea.12441.
Immediate hypersensitivity to corticosteroids is reported to occur with an incidence of 0.1%. The largest previous case series reporting corticosteroid skin testing has seven patients.
We identified 23 patients (mean age 50 years, 65% female) from Auckland City Hospital who underwent skin testing (ST) for suspected corticosteroid hypersensitivity between July 2005 and April 2012. We performed a retrospective clinical case note review detailing clinical history of reaction, skin test results and subsequent management. Most patients (21/23) had a standard panel of testing with prednisolone, triamcinolone, methylprednisolone, hydrocortisone and dexamethasone. Skin tests used a 10% steroid stock concentration for skin prick tests (SPT) and dilutions of 1 : 1000, 1 : 100 and 1 : 10 for subsequent intradermal testing. A weal 3 mm greater than the negative control was considered positive.
A total of 23 patients were identified who had skin testing for suspected acute hypersensitivity to corticosteroids, eight of which had a history of anaphylaxis. From 28 reactions (in 23 patients), the most common route of administration was intra-articular (13), followed by oral (7), intravenous (3) and other (5). Skin tests were positive in 8/23 patients, and 7/8 of these patients had a history of corticosteroid-associated anaphylaxis. Skin tests were positive at either the skin prick test or intradermal stages. There was evidence suggesting clinical and skin test cross-reactivity between corticosteroids in one patient. One patient had a positive skin test, but negative oral challenge suggesting the skin test was false positive. Skin tests were negative in 15/23 patients. One patient had a negative prednisolone skin test and positive unblinded oral challenge, suggesting a false-negative skin test.
Skin testing can provide sufficient evidence to diagnose allergy in patients with a clear history of immediate hypersensitivity to corticosteroids such as anaphylaxis. Both skin prick and intradermal tests should be used. There is evidence of cross-reactivity between steroids, so a panel is recommended. False-positive and false-negative reactions do occur; however, the frequency is unknown. Challenge remains the only definitive way to demonstrate a safe alternative to use.
As the largest case series described, this article provides new evidence for the interpretation of skin tests when investigating possible immediate hypersensitivity to corticosteroids.
据报道，皮质类固醇的即刻过敏反应发生率为 0.1%。此前报告皮质类固醇皮肤试验的最大病例系列研究有 7 例患者。
我们从奥克兰市医院确定了 23 名（平均年龄 50 岁，65%为女性）患者，他们在 2005 年 7 月至 2012 年 4 月期间因疑似皮质类固醇过敏而接受皮肤试验（ST）。我们进行了一项回顾性临床病历回顾，详细描述了反应的临床病史、皮肤试验结果和随后的管理。大多数患者（23 例中的 21 例）接受了标准的皮质类固醇检测，包括泼尼松龙、曲安奈德、甲泼尼龙、氢化可的松和地塞米松。皮肤试验使用 10%类固醇原液进行皮肤点刺试验（SPT），并对 1:1000、1:100 和 1:10 的稀释液进行随后的皮内试验。比阴性对照强 3 毫米的风团被认为是阳性。
我们确定了 23 名疑似皮质类固醇急性过敏反应的患者进行了皮肤试验，其中 8 名有过敏反应史。在 23 名患者的 28 次反应中，最常见的给药途径是关节内（13 次），其次是口服（7 次）、静脉内（3 次）和其他（5 次）。23 例患者中有 8 例皮肤试验阳性，其中 7 例有皮质类固醇相关过敏反应史。皮肤试验在皮内或皮内阶段均为阳性。有证据表明，1 名患者的皮质类固醇之间存在临床和皮肤试验交叉反应。1 名患者皮肤试验阳性，但口服挑战阴性，提示皮肤试验假阳性。23 例患者中有 15 例皮肤试验阴性。1 例患者皮试阴性，盲法口服挑战阳性，提示皮试假阴性。
皮肤试验可为明确有皮质类固醇即刻过敏反应史（如过敏反应）的患者提供充分的证据，以诊断过敏。应同时使用皮肤点刺试验和皮内试验。有证据表明类固醇之间存在交叉反应，因此建议使用试剂盒。确实会出现假阳性和假阴性反应；但是，频率未知。挑战仍然是唯一确定安全替代方法的方法。
作为描述的最大病例系列，本文为研究皮质类固醇即刻过敏反应时解释皮肤试验提供了新的证据。
