Effective prescribing in steroid allergy: Controversies and cross-reactions

• Published in: Clinics in dermatology Vol. 29; no. 3; pp. 287 - 294
• Main Authors: Browne, Fiona, BA, MRCP, Wilkinson, S. Mark, MD, FRCP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2011
• Subjects: Administration, Topical; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Cross Reactions; Dermatitis, Allergic Contact - diagnosis; Dermatitis, Allergic Contact - drug therapy; Dermatitis, Allergic Contact - etiology; Dermatologic Agents - administration & dosage; Dermatologic Agents - adverse effects; Dermatology; Drug Eruptions - diagnosis; Drug Eruptions - drug therapy; Drug Eruptions - etiology; Drug Interactions - immunology; Europe; Humans; Patch Tests - methods; Treatment Outcome; Europe
• ISSN: 0738-081X; 1879-1131
• DOI: 10.1016/j.clindermatol.2010.11.007

Abstract Contact allergy to topical corticosteroids should be considered in all patients who do not respond to, or are made worse by, the use of topical steroids. The incidence of steroid allergy in such patients is reported as 9% to 22% in adult patients and in 25% of children. It can often go undiagnosed for a long time in patients with a long history of dermatologic conditions and steroid use. Although rare, both immediate and delayed-type hypersensitivity reactions have been reported to systemic corticosteroids with an incidence of 0.3%. Reported reactions range from localized eczematous eruptions to systemic reactions, anaphylaxis, and even death. Delayed type reactions to systemically administered steroids may present as a generalized dermatitis, an exanthematous eruption, or occasionally, with blistering or purpura. In this contribution, we clarify the issues surrounding the pathogenesis of steroid allergy, cover the importance of cross-reactions, and describe strategies for the investigation and management for patients with suspected steroid allergy.