[Utility of challenge test in immediate hypersensitivity to hydrocortisone sodium succinate]

Rev Alerg Mex. Jan-Mar 2014;61(1):32-7.
[Article in Spanish]

Abstract

Corticosteroid hypersensitivity is a complex phenomenon in which many factors interact, such as idiosyncrasy, intolerance or allergic reactions. The prevalence of immediate hypersensitivity reactions to corticosteroids is 0.2%-0.5%. Corticosteroids have major therapeutic implications; thus, when hypersensitivity is suspected, in-vitro and/or in-vivo testing can be performed to confirm diagnosis, being the drug challenge the gold standard. After definitive diagnosis, cross-reactivity among the different corticosteroid groups should be considered, to choose wisely if corticosteroid therapy is still required. In Coopman classification, steroids belonging to groups A, B and D2 have high cross-reactivity, however, more studies are needed to determine the degree of cross-reaction among these drugs. This paper presents the case of a woman, in who hypersensitivity to hydrocortisone succinate was confirmed by drug challenge test.

La hipersensibilidad a corticoesteroides es un fenómeno complejo en el que interactúan múltiples factores como idiosincrasia, intolerancia o alergia. La prevalencia de las reacciones de hipersensibilidad inmediata a corticoesteroides es de 0.2 a 0.5%. Debido a la relevancia terapéutica de los esteroides, es importante confirmar el diagnóstico de hipersensibilidad con pruebas in vivo, in vitro, o ambas, el patrón de referencia es la prueba de reto con el fármaco implicado. Una vez realizado el diagnóstico y en caso de que se requiera continuar con el tratamiento con esteroides, deberá considerarse la reactividad cruzada entre los diferentes grupos propuestos en la clasificación de Coopman, en la que los corticoesteroides pertenecientes a los grupos A, B y D2 tienen una elevada reactividad cruzada entre sí; sin embargo, hacen falta más estudios para determinar el grado de reactividad cruzada entre estos fármacos. Comunicamos el caso de una paciente en la que se confirmó el diagnóstico de hipersensibilidad a succinato de hidrocortisona con la prueba de reto.

Keywords: Corticosteroids; Cross-reactivity; Drug challenge test; Hypersensitivity.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Oral
  • Adrenal Cortex Hormones / chemistry
  • Adrenal Cortex Hormones / classification
  • Adrenal Cortex Hormones / immunology
  • Adrenal Cortex Hormones / pharmacokinetics
  • Adult
  • Anaphylaxis / chemically induced
  • Angioedema / chemically induced
  • Cross Reactions
  • Dose-Response Relationship, Drug
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / etiology
  • Drug Hypersensitivity / physiopathology
  • Female
  • Haptens / immunology
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / adverse effects
  • Hydrocortisone / analogs & derivatives*
  • Hydrocortisone / immunology
  • Hypersensitivity, Immediate / chemically induced
  • Hypersensitivity, Immediate / diagnosis*
  • Hypersensitivity, Immediate / physiopathology
  • Molecular Structure
  • Structure-Activity Relationship

Substances

  • Adrenal Cortex Hormones
  • Haptens
  • hydrocortisone hemisuccinate
  • Hydrocortisone