Corticosteroid hypersensitivity studies in a skin allergy clinic

Introduction: Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid- allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristic sto those of others treated at our clinic. Material and methods: Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11- year period. Results: We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid- allergic patients. All were allergic to a group 1 corticosteroid( most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/ or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty- one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them( 61.9%) did not develop a hypersensitivity reaction. Conclusions: The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series anda patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids. (C) 2015 Elsevier Espanma, S.L.U. and AEDV. All rights reserved.