ANAPHYLAXIS INDUCED BY THE CARBOXYMETHYLCELLULOSE COMPONENT OF INJECTABLE TRIAMCINOLONE ACETONIDE SUSPENSION (KENALOG)

Background: Allergic reactions to various corticosteroids are rare but have been reported previously. Objective: We wished to determine the etiology of an anaphylactic reaction in a patient who had received int racutaneous Kenalog (triamcinolone acetonide). Methods: Skin testing a nd serologic testing for allergen-specific IgE antibodies was performe d for triamcinolone acetonide, its individual components, and three ot her corticosteroid preparations in both the patient and six other nona llergic persons. Results: The patient had positive skin tests to only the carboxymethylcellulose component of triamcinolone acetonide. He ha d negative skin test reactions to three other steroid preparations whi ch did not contain carboxymethyicellulose. Specific IgE antibodies to carboxymethylcellulose were also elevated by immunoassay and immunoblo tting. Control patients had negative skin tests to triamcinolone aceto nide, its components, and three other corticosteroid preparations, and their sera lacked significant specific IgE antibodies to these materi als. Conclusions: Our results indicate that the triamcinolone acetonid e component responsible for the patient's reaction was the suspending agent carboxymethylcellulose. We urge physicians to consider component testing when patients experience allergic-type reactions to drugs.