Hypersensitivity reactions to corticosteroids

Rani R. Vatti, Fatima Ali, Suzanne S Teuber, Christopher Chang, M. Eric Gershwin

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Hypersensitivity reactions to corticosteroids (CS) are rare in the general population, but they are not uncommon in high-risk groups such as patients who receive repeated doses of CS. Hypersensitivity reactions to steroids are broadly divided into two categories: immediate reactions, typically occurring within 1 h of drug administration, and non-immediate reactions, which manifest more than an hour after drug administration. The latter group is more common. We reviewed the literature using the search terms "hypersensitivity to steroids, adverse effects of steroids, steroid allergy, allergic contact dermatitis, corticosteroid side effects, and type I hypersensitivity" to identify studies or clinical reports of steroid hypersensitivity. We discuss the prevalence, mechanism, presentation, evaluation, and therapeutic options in corticosteroid hypersensitivity reactions. There is a paucity of literature on corticosteroid allergy, with most reports being case reports. Most reports involve non-systemic application of corticosteroids. Steroid hypersensitivity has been associated with type I IgE-mediated allergy including anaphylaxis. The overall prevalence of type I steroid hypersensitivity is estimated to be 0.3-0.5 %. Allergic contact dermatitis (ACD) is the most commonly reported non-immediate hypersensitivity reaction and usually follows topical CS application. Atopic dermatitis and stasis dermatitis of the lower extremities are risk factors for the development of ACD from topical CS. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS. A close and detailed evaluation is required for the clinician to confirm the presence of a true hypersensitivity reaction to the suspected drug and choose the safest alternative. Choosing an alternative CS is not only paramount to the patient's safety but also ameliorates the worry of developing an allergic, and potentially fatal, steroid hypersensitivity reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. The assessment should be done when the patient's underlying condition is in a quiescent state.

Original languageEnglish (US)
Pages (from-to)26-37
Number of pages12
JournalClinical Reviews in Allergy and Immunology
Volume47
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Adrenal Cortex Hormones
Hypersensitivity
Steroids
Allergic Contact Dermatitis
Immediate Hypersensitivity
Pharmaceutical Preparations
Anaphylaxis
Dermatitis
Atopic Dermatitis
Patient Safety
Nose
Immunoglobulin E
Lower Extremity

Keywords

  • Allergic contact dermatitis
  • Allergic reaction
  • Allergy
  • Anaphylaxis
  • Asthma
  • Atopy
  • Corticosteroids
  • Cross-reactivity
  • Delayed type
  • Glucocorticoids
  • Hypersensitivity
  • Immediate type
  • Inhaled steroid
  • Intra-articular steroid
  • Intranasal steroid
  • Non-immediate reactions
  • Sensitization
  • Steroids
  • Systemic
  • Systemic steroid
  • The Coopman steroid classification system
  • Topical

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Hypersensitivity reactions to corticosteroids. / Vatti, Rani R.; Ali, Fatima; Teuber, Suzanne S; Chang, Christopher; Gershwin, M. Eric.

In: Clinical Reviews in Allergy and Immunology, Vol. 47, No. 1, 2014, p. 26-37.

Research output: Contribution to journalArticle

Vatti, Rani R. ; Ali, Fatima ; Teuber, Suzanne S ; Chang, Christopher ; Gershwin, M. Eric. / Hypersensitivity reactions to corticosteroids. In: Clinical Reviews in Allergy and Immunology. 2014 ; Vol. 47, No. 1. pp. 26-37.
@article{7a897b4181ef4e0a80f69444e1d3f95f,
title = "Hypersensitivity reactions to corticosteroids",
abstract = "Hypersensitivity reactions to corticosteroids (CS) are rare in the general population, but they are not uncommon in high-risk groups such as patients who receive repeated doses of CS. Hypersensitivity reactions to steroids are broadly divided into two categories: immediate reactions, typically occurring within 1 h of drug administration, and non-immediate reactions, which manifest more than an hour after drug administration. The latter group is more common. We reviewed the literature using the search terms {"}hypersensitivity to steroids, adverse effects of steroids, steroid allergy, allergic contact dermatitis, corticosteroid side effects, and type I hypersensitivity{"} to identify studies or clinical reports of steroid hypersensitivity. We discuss the prevalence, mechanism, presentation, evaluation, and therapeutic options in corticosteroid hypersensitivity reactions. There is a paucity of literature on corticosteroid allergy, with most reports being case reports. Most reports involve non-systemic application of corticosteroids. Steroid hypersensitivity has been associated with type I IgE-mediated allergy including anaphylaxis. The overall prevalence of type I steroid hypersensitivity is estimated to be 0.3-0.5 {\%}. Allergic contact dermatitis (ACD) is the most commonly reported non-immediate hypersensitivity reaction and usually follows topical CS application. Atopic dermatitis and stasis dermatitis of the lower extremities are risk factors for the development of ACD from topical CS. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS. A close and detailed evaluation is required for the clinician to confirm the presence of a true hypersensitivity reaction to the suspected drug and choose the safest alternative. Choosing an alternative CS is not only paramount to the patient's safety but also ameliorates the worry of developing an allergic, and potentially fatal, steroid hypersensitivity reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. The assessment should be done when the patient's underlying condition is in a quiescent state.",
keywords = "Allergic contact dermatitis, Allergic reaction, Allergy, Anaphylaxis, Asthma, Atopy, Corticosteroids, Cross-reactivity, Delayed type, Glucocorticoids, Hypersensitivity, Immediate type, Inhaled steroid, Intra-articular steroid, Intranasal steroid, Non-immediate reactions, Sensitization, Steroids, Systemic, Systemic steroid, The Coopman steroid classification system, Topical",
author = "Vatti, {Rani R.} and Fatima Ali and Teuber, {Suzanne S} and Christopher Chang and Gershwin, {M. Eric}",
year = "2014",
doi = "10.1007/s12016-013-8365-z",
language = "English (US)",
volume = "47",
pages = "26--37",
journal = "Clinical Reviews in Allergy and Immunology",
issn = "1080-0549",
publisher = "Humana Press",
number = "1",

}

TY - JOUR

T1 - Hypersensitivity reactions to corticosteroids

AU - Vatti, Rani R.

AU - Ali, Fatima

AU - Teuber, Suzanne S

AU - Chang, Christopher

AU - Gershwin, M. Eric

PY - 2014

Y1 - 2014

N2 - Hypersensitivity reactions to corticosteroids (CS) are rare in the general population, but they are not uncommon in high-risk groups such as patients who receive repeated doses of CS. Hypersensitivity reactions to steroids are broadly divided into two categories: immediate reactions, typically occurring within 1 h of drug administration, and non-immediate reactions, which manifest more than an hour after drug administration. The latter group is more common. We reviewed the literature using the search terms "hypersensitivity to steroids, adverse effects of steroids, steroid allergy, allergic contact dermatitis, corticosteroid side effects, and type I hypersensitivity" to identify studies or clinical reports of steroid hypersensitivity. We discuss the prevalence, mechanism, presentation, evaluation, and therapeutic options in corticosteroid hypersensitivity reactions. There is a paucity of literature on corticosteroid allergy, with most reports being case reports. Most reports involve non-systemic application of corticosteroids. Steroid hypersensitivity has been associated with type I IgE-mediated allergy including anaphylaxis. The overall prevalence of type I steroid hypersensitivity is estimated to be 0.3-0.5 %. Allergic contact dermatitis (ACD) is the most commonly reported non-immediate hypersensitivity reaction and usually follows topical CS application. Atopic dermatitis and stasis dermatitis of the lower extremities are risk factors for the development of ACD from topical CS. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS. A close and detailed evaluation is required for the clinician to confirm the presence of a true hypersensitivity reaction to the suspected drug and choose the safest alternative. Choosing an alternative CS is not only paramount to the patient's safety but also ameliorates the worry of developing an allergic, and potentially fatal, steroid hypersensitivity reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. The assessment should be done when the patient's underlying condition is in a quiescent state.

AB - Hypersensitivity reactions to corticosteroids (CS) are rare in the general population, but they are not uncommon in high-risk groups such as patients who receive repeated doses of CS. Hypersensitivity reactions to steroids are broadly divided into two categories: immediate reactions, typically occurring within 1 h of drug administration, and non-immediate reactions, which manifest more than an hour after drug administration. The latter group is more common. We reviewed the literature using the search terms "hypersensitivity to steroids, adverse effects of steroids, steroid allergy, allergic contact dermatitis, corticosteroid side effects, and type I hypersensitivity" to identify studies or clinical reports of steroid hypersensitivity. We discuss the prevalence, mechanism, presentation, evaluation, and therapeutic options in corticosteroid hypersensitivity reactions. There is a paucity of literature on corticosteroid allergy, with most reports being case reports. Most reports involve non-systemic application of corticosteroids. Steroid hypersensitivity has been associated with type I IgE-mediated allergy including anaphylaxis. The overall prevalence of type I steroid hypersensitivity is estimated to be 0.3-0.5 %. Allergic contact dermatitis (ACD) is the most commonly reported non-immediate hypersensitivity reaction and usually follows topical CS application. Atopic dermatitis and stasis dermatitis of the lower extremities are risk factors for the development of ACD from topical CS. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS. A close and detailed evaluation is required for the clinician to confirm the presence of a true hypersensitivity reaction to the suspected drug and choose the safest alternative. Choosing an alternative CS is not only paramount to the patient's safety but also ameliorates the worry of developing an allergic, and potentially fatal, steroid hypersensitivity reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. The assessment should be done when the patient's underlying condition is in a quiescent state.

KW - Allergic contact dermatitis

KW - Allergic reaction

KW - Allergy

KW - Anaphylaxis

KW - Asthma

KW - Atopy

KW - Corticosteroids

KW - Cross-reactivity

KW - Delayed type

KW - Glucocorticoids

KW - Hypersensitivity

KW - Immediate type

KW - Inhaled steroid

KW - Intra-articular steroid

KW - Intranasal steroid

KW - Non-immediate reactions

KW - Sensitization

KW - Steroids

KW - Systemic

KW - Systemic steroid

KW - The Coopman steroid classification system

KW - Topical

UR - http://www.scopus.com/inward/record.url?scp=84906227176&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906227176&partnerID=8YFLogxK

U2 - 10.1007/s12016-013-8365-z

DO - 10.1007/s12016-013-8365-z

M3 - Article

C2 - 23567983

AN - SCOPUS:84906227176

VL - 47

SP - 26

EP - 37

JO - Clinical Reviews in Allergy and Immunology

JF - Clinical Reviews in Allergy and Immunology

SN - 1080-0549

IS - 1

ER -