Otani Iris M, Banerji Aleena
Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
Curr Allergy Asthma Rep. 2016 Mar;16(3):18. doi: 10.1007/s11882-016-0596-7.
Corticosteroids are anti-inflammatory medications used widely to treat allergic inflammation. Although the endocrine and gastrointestinal side effects of corticosteroids have been described, the occurrence of immediate hypersensitivity reactions and delayed contact dermatitis due to corticosteroids remains under-recognized. Hypersensitivity reactions can occur to a corticosteroid itself, or to the additives and vehicles in corticosteroid preparations. Skin testing and oral graded challenge can help confirm the suspected culprit agent in immediate hypersensitivity reactions and help identify an alternative tolerated corticosteroid. Patch testing can help identify the culprit agents in delayed hypersensitivity contact dermatitis. Cross-reactivity patterns have not been observed for immediate hypersensitivity reactions as they have been for delayed contact dermatitis. Sensitization in contact dermatitis exhibits cross-reactivity patterns based on corticosteroid structure. We review the current understanding regarding the clinical presentation, evaluation, and management of immediate and delayed hypersensitivity reactions to corticosteroids.
皮质类固醇是广泛用于治疗过敏性炎症的抗炎药物。尽管皮质类固醇的内分泌和胃肠道副作用已有描述，但皮质类固醇引起的速发型超敏反应和迟发性接触性皮炎的发生仍未得到充分认识。超敏反应可能发生在皮质类固醇本身，也可能发生在皮质类固醇制剂中的添加剂和赋形剂上。皮肤试验和口服分级激发试验有助于确认速发型超敏反应中可疑的致病剂，并有助于确定另一种可耐受的皮质类固醇。斑贴试验有助于识别迟发性超敏接触性皮炎中的致病剂。速发型超敏反应未观察到交叉反应模式，而迟发性接触性皮炎则有交叉反应模式。接触性皮炎中的致敏表现出基于皮质类固醇结构的交叉反应模式。我们综述了目前对皮质类固醇速发型和迟发性超敏反应的临床表现、评估和管理的认识。
