Immediate-Type Hypersensitivity to Succinylated Corticosteroids

Background: Despite their frequent use, systemic corticosteroids
have rarely elicited immediate-type reactions. Objective: We report
two male patients, aged 26 and 70 years, respectively, with severe
immediate-type hypersensitivity secondary to the administration of
corticosteroids esterified with succinate. Methods: Skin tests,
basophil activation tests and challenge tests were performed for
diagnostic evaluation. Results: In both patients, immediate-type
skin test reactions were found to methylprednisolone sodium
hemisuccinate (MSH) and prednisolone sodium hemisuccinate (PSH). In
contrast, nonsuccinylated corticosteroids (including
methylprednisolone and prednisolone in one patient) yielded no test
reactions. Basophils from one patient exhibited a stimulated
expression of the activation marker CD63 upon in vitro incubation
with PSH or hydrocortisone sodium succinate, but not with
hydrocortisone. Skin tests and basophil activation tests were
negative in controls. One patient was challenged with the
incriminated drugs. He developed flush, conjunctivitis, tachycardia
and dyspnea 2 min after injection of MSH, and dyspnea shortly after
intravenous administration of PSH. Oral and intravenous challenge
tests with nonsuccinylated corticosteroids were tolerated well by
both patients. Conclusions: These case reports should alert
clinicians to rare, but severe immediate-type reactions to
corticosteroids, related to the succinate moiety in our patients.
In case of allergic reactions to corticosteroids, it is mandatory
to identify the causative agent and find safe alternatives.
Copyright (C) 2010 S. Karger AG, Basel