Clinical significance of allergic reactions, following glucocorticosteroidtherapy

Background: Glucocorticoids are widely used in medicine. Within the last fe w years, however, patients have become very suspicious of corticoids. The a ttending physicians frequently has to use a great deal of persuasion prior to applying this very effective and often indispendable group of medication . Patients: We report on four patients who developed allergic reactions (i. e. erythema in face and on body, itching, flushing, drop in blood pressure, respiratory distress, cold sweats, etc.) immediately after intravenous adm inistration of prednisolone-21 hydrogen succinate (Solu-Decortin H(R), SDH) . Results: Three out of four patients had a positive reaction to an intracu taneous test with SDH, but no reaction to the additive sodium succinate. Th e pride test was negative in all patients. No specific IgE antibodies were detected in the serum of these patients. However allergic reaction to SDH m ust be presumed in at least three cases as it is difficult to detect glucoc orticoid antibodies in serum and standardizes techniques are lacking. One f emale patient had a cross-reaction to prednisolon and dexamethasone. A rene wed application of SDH was tolerated well by all patients when H-1- and H-2 -receptors were blocked and calcium was administered to stabilize membranes . Conclusions: Allergic reactions after glucocorticosteroid therapy are onl y occasionally mentioned in literature, appear more often when the agent is applied topically, and may lead to dangerous complications in patients if administered intravenously. Therefore, when allergic reactions result from glucocorticoid therapy (immediate reactions should be suspect), corticoster oid allergy should be considered as a differential diagnosis.