Allergic-type reactions to corticosteroids

OBJECTIVE: TO review reported cases of suspected allergic reactions to vari ous corticosteroids. DATA SOURCES: A MEDLINE search (January 1966-December 1997) was performed t o obtain case reports and review articles on allergic-type reactions to cor ticosteroids. Further references were obtained from these publications. STUDY SELECTION: Reports involving allergic or allergic-type reactions to s ystemic administration of corticosteroids were chosen for this review. An a llergic-type reaction was defined as any reaction after administration of t he drug that involved the appearance of adverse symptoms that are character istic of unwanted immune responses. These symptoms include rash, sneezing, dyspnea, edema, bronchospasm, or death. Articles were excluded from the eva luation if they described reactions to topical, intraarticular, or ophthalm ic corticosteroid administration. DATA SYNTHESIS: Corticosteroids are medications that are often used to trea t allergic reactions. However, it appears that patients can also have aller gic-type reactions to these agents. The severity of the reaction can vary f rom a rash to anaphylaxis or death. Both immediate and delayed reactions ca n occur. Allergic-type reactions are reported to occur more frequently in a sthmatic and renal transplant patients than other patient populations. Howe ver, it is questionable whether all of these are true allergic responses, a s there is conflicting evidence regarding the mechanism of the reaction. Th e most commonly implicated corticosteroids are methylprednisolone and hydro cortisone, but reactions have also occurred with others. Intradermal skin t esting can help determine cross-sensitivity, although its value has not bee n conclusively demonstrated. CONCLUSIONS: Clinicians should be aware that allergic reactions to corticos teroids are possible. Worsening of symptoms may not always mean treatment f ailure, but may indicate an allergic reaction. High doses of corticosteroid s (greater than or equal to 500 mg) should be given over 30-60 minutes, and patients should be observed after administration for at least the same tim e period. Asthmatics, renal transplant patients, and hemodynamically unstab le patients may be at higher risk for adverse events. If a patient is found to be allergic to one corticosteroid, intradermal skin testing may help id entify another corticosteroid that can be tolerated.