López-Serrano M C, Moreno-Ancillo A, Contreras J, Ortega N, Cabañas R, Barranco P, Muñoz-Pereira M
Servicio de Alergia, Hospital General Universitario La Paz, Madrid, Spain.
J Investig Allergol Clin Immunol. 1996 Sep-Oct;6(5):324-7.
Although true allergic reactions due to systemic corticosteroid therapy are not frequent, they should be kept in mind since allergic reactions to this kind of therapy are possible. We report two cases of specific adverse reactions resulting from systemic corticosteroid therapy which were diagnosed by provocation tests. The corticosteroids involved in each case were paramethasone and betamethasone, and methyl-prednisolone in both of them. Additives and other corticosteroids were studied by skin tests and challenges, with negative results. The structures of paramethasone and betamethasone are similar, with a 16 carbon methyl group in both, and with a fluoride in the alpha position of the 6 carbon in paramethasone, and a fluoride in the beta position of the 9 carbon and a 6 carbon methyl group in betamethasone. Methyl-prednisolone differs from that of other corticosteroids in its 6 carbon methyl group. We report two cases of specific adverse reactions caused by corticosteroids. Positive challenge tests showed a possible immunologic hypersensitivity mechanism in both cases. The patients' reactions demonstrated cross-reactivity between methyl-prednisolone and the corticosteroids having a 16 carbon methyl group, and fluoride or methyl radicals on the 6 carbon.
虽然全身性皮质类固醇治疗引起的真正过敏反应并不常见，但由于对这类治疗可能会出现过敏反应，所以应予以关注。我们报告两例因全身性皮质类固醇治疗导致的特定不良反应，这两例均通过激发试验确诊。每例所涉及的皮质类固醇分别为对氟米松和倍他米松，两例中均有甲泼尼龙。通过皮肤试验和激发试验研究了添加剂及其他皮质类固醇，结果均为阴性。对氟米松和倍他米松的结构相似，二者均有一个16位碳甲基，对氟米松在6位碳的α位有一个氟原子，倍他米松在9位碳的β位有一个氟原子且在6位碳有一个甲基。甲泼尼龙与其他皮质类固醇的不同之处在于其6位碳有一个甲基。我们报告两例由皮质类固醇引起的特定不良反应。激发试验阳性表明两例均可能存在免疫超敏反应机制。患者的反应显示甲泼尼龙与具有16位碳甲基且在6位碳有氟原子或甲基基团的皮质类固醇之间存在交叉反应。
