Berbegal L, DeLeon F J, Silvestre J F
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
Actas Dermosifiliogr. 2015 Dec;106(10):816-22. doi: 10.1016/j.ad.2015.07.007. Epub 2015 Sep 4.
Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic.
Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period.
We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction.
The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids.
皮质类固醇可引起超敏反应，尤其是迟发型过敏反应。一种用于检测对皮质类固醇超敏反应的新分类系统根据分子结构将药物分为3组；患者根据其是否对1组或更多组中的药物过敏进行分类。我们旨在描述在我们诊所接受治疗的皮质类固醇过敏患者的临床特征，并将新分类系统应用于他们；我们还将这些患者的特征与在我们诊所接受治疗的其他患者的特征进行了比较。
对一家三级医院皮肤过敏诊所11年间治疗的迟发型皮质类固醇超敏反应病例进行回顾性研究。
我们查阅了2857例患者的记录，发现33例患者至少有一项斑贴试验阳性结果显示皮质类固醇超敏反应。特应性皮炎和手部受累在我们的皮质类固醇过敏患者中不太常见。所有患者均对1组皮质类固醇过敏（最常见的是布地奈德，87.9%的病例由其引起）。使用特定皮质类固醇系列进行检测发现，14例（42.4%）患者也对2组和/或3组中的皮质类固醇过敏。无一例患者仅对2组或3组药物过敏。21例患者接触了其斑贴试验结果显示过敏的一组皮质类固醇乳膏；其中13例（61.9%）未发生超敏反应。
西班牙标准系列仅包含1组皮质类固醇。为了改善过敏管理，我们建议每当标准系列斑贴试验显示对皮质类固醇超敏反应时，使用特定皮质类固醇系列和患者自己的乳膏进行检测。
