REACTIVITY OF TIXOCORTOL PIVALATE-POSITIVE PATIENTS IN INTRADERMAL AND ORAL PROVOCATION TESTS

Pivalone(R)/tixocortol pivalate commonly yields positive reactions in the patch test series. The clinical relevance of these positive reacti ons was investigated in more detail, In the standard patch test series 5.6% (73 of 1306) of the patients were positive to corticosteroids, 5 .2% to 0.1% tixocortol pivalate in ethanol (Pivalone(R) nasal spray di luted 1:10) and 2.3% to 1% hydrocortisone butyrate in ethanol. Some of the patients were tested in parallel with Pivalone(R) and 1% tixocort ol pivalate in petrolatum. The former test reagent yielded some false- positive reactions, whereas with the latter, some allergic responses w ere missed. Intradermal tests with the succinate esters of hydrocortis one, methylprednisolone and prednisolone were performed with 52 patien ts positive to Pivalone(R). Of these 76.9% (40 of 52) were positive in the intradermal tests; 38 to hydrocortisone, 35 to methylprednisolone and 30 to prednisolone. Twelve patients who had been positive in the intradermal tests were challenged orally with corticosteroids and they all showed positive reactions to hydrocortisone, methylprednisolone o r prednisolone. The patients developed localized reactions at the site s of previous eczema or positive skin tests or diffuse erythema or exa nthema. The oral doses of hydrocortisone eliciting positive delayed sk in reactions ranged from 20 to 200 mg, Reactivity to tixocortol pivala te is closely related to sensitivity to hydrocortisone, methylpredniso lone and prednisolone, but high oral doses of these corticosteroids ma y be required to produce allergic symptoms.