Alternative glucocorticoids for use in cases of adverse reaction to systemic glucocorticoids: a study on 10 patients

Background Reactions to systemically administered corticosteroids are rare, despite their widespread use. Objectives To identify alternative glucocorticoids for emergency use in patients with adverse reactions to systemic glucocorticoids. Methods Ten patients were identified as having adverse reactions after the use of systemic corticosteroids. Skin prick tests and intradermal tests to hydrocortisone (HC) and methylprednisolone (MP), and intradermal tests to betamethasone and dexamethasone, were performed in all patients, and oral challenge tests to betamethasone (n =10) and deflazacort (n =6). Results Skin prick tests were negative in all patients, whereas intradermal tests to HC and MP were positive in eight; two patients showed only an isolated cutaneous sensitivity to MP. Intradermal tests to betamethasone and dexamethasone were negative, and oral challenge tests were negative in all patients. Conclusions Our results suggest the possibility of an IgE-mediated mechanism for allergic reactions to HC and MP, probably due, at least in part, to a steroid-glyoxal. We suggest that betamethasone and deflazacort could be reserved for emergency use in patients with adverse reactions to other corticosteroids.