1. Immunoallergology Department, Hospital Dona Estefânia, CHULC, EPE, Lisbon, Portugal
2. CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisbon, Portugal
- Reunião Internacional, apresentação sob a forma de poster – EAACI Congress, 1 a 5 de Junho de 2019, Lisboa
Caso Clínico:
Introduction: Corticosteroids (CS) are widely used for their anti-inflammatory effects. As corticosteroids are often used to treat allergic reactions, they can be overlooked as a cause of immune-mediated hypersensitivity reactions (HS). However, allergic reactions to CS have been reported with an estimated prevalence of 0.1 to 0.3 %, being the delayed type reactions to topical CS more frequent than the immediate-type.
Case Report: A 42-year-old woman presented with a history of several episodes of HS to the administration of endovenous and topical CS. The first episode occurred during adolescence, with facial angioedema following the administration of an unknown endovenous CS. The second episode occurred in her 20’s, also with facial angioedema following the administration of intranasal CS (budesonide). More recently, she had experienced late contact dermatitis after manipulating her son’s intranasal CS (both fluticasone furoate, mometasone furoate and beclomethasone). She also has a non-atopic persistent rhinitis and does not tolerate any nasal CS. Skin prick tests (SPT) and intradermal tests (ITD) with CS (prednisolone, methylprednisolone succinate, hydrocortisone succinate, dexamethasone phosphate, betamethasone) and latex were negative, including immediate and late readings. We decided to do an oral drug challenge with deflazacort (total dose 33mg) that was positive – generalized erythematous reaction and palpebral edema 3h after administration. A month later we performed a drug challenge with endovenous dexamethasone (5mg) and later with oral betamethasone (5mg), both negative. We performed patch tests with the CS present in the GPEDC (Grupo Português de Estudo das Dermatites de Contacto) portuguese baseline series (budesonide and hydrocortisone butyrate) as well as with the available nasal CS (fluticasone furoate and budesonide). At the 48h reading, the patch test was strongly positive to budesonide and after 96h it was positive to all CS tested.
Conclusions: This case illustrates the challenging management of CS allergy. HS to deflazacort was confirmed but we were not able to identify the culprit of EV CS reaction. We found tolerated options for systemic administration (oral and ev), but still haven’t found a nasal CS that can treat what the patient needs the most, her non-atopic rhinitis.
Written consent to share clinical information was given by the patient.
Palavras Chave: corticosterois hypersensitivity