Topical corticosteroid allergy: Results of sequential testing to a corticosteroid series in New Zealand

Background: Our institution tests the European Baseline Series (EBS) and a steroid series sequentially in all patients presenting for patch testing. The rate of steroid sensitization in New Zealand has not previously been documented. Objectives: To investigate the rate of corticosteroid sensitization and assess additional benefit of testing the full steroid series over the steroid allergy markers in the EBS. Methods/Patients: Retrospective analysis of all patient demographics and patch test results over a 5-year period (2014 to 2019) was performed at a tertiary patch test clinic in Auckland, New Zealand. Results: A total of 319 patients completed patch testing, and 4.4% were sensitized to one or more corticosteroids. As much as 79% of positive reactions were of current relevance; 11/14 reactions were to tixocortol pivalate or budesonide. The number needed to test to detect one additional case of corticosteroid sensitization by using the full corticosteroid series over the EBS alone was 107. Conclusions: Although corticosteroid sensitization was not uncommon in our population, the results suggest that sequential testing with the corticosteroid markers (budesonide and tixocortol) in the standard series alone is adequate. The additional corticosteroid series should be added if the markers are positive or where there is a clinical suspicion of corticosteroid allergy. Highlights We report a patch testing sensitization rate in Auckland, New Zealand, of 4.4%, to at least one corticosteroid tested. The number needed to test to detect one additional case of corticosteroid allergy by using the full steroid series (19 additional allergens) over the European Baseline Series (EBS) alone (includes markers tixocortol pivalate and budesonide) was 107. As much as 11/14 corticosteroid reactions were to tixocortol pivalate or budesonide.

Automated summary

The study found a sensitization rate of 4.4% to at least one corticosteroid tested in Auckland, New Zealand through patch testing. Using the full steroid series, in addition to the European Baseline Series, was able to detect one additional case of corticosteroid allergy with a number needed to test of 107. Up to 11 out of 14 corticosteroid reactions were to tixocortol pivalate or budesonide.