Immediate and delayed allergic hypersensitivity to corticosteroids: practical guidelines

Background. Corticosteroids (CS), anti-inflammatory drugs also widely used to treat various allergic diseases, may themselves give rise to immediate and delayed allergic hypersensitivity reactions. Objectives. To realise an appropriate diagnostic work-up in order to determine the CS-allergic patient's sensitization/ tolerance profile and define the potential replacement agents that can still be tolerated. Methods. Analysis of the patch test results and concomitant (cross-) reaction patterns obtained with 315 corticosteroid-allergic patients, as well as molecular modelling of molecules. Results. Proposal of a simplified classification of corticosteroids as to their allergenic properties into 3 groups, determination of two patient profiles according to steric and electrostatic properties of the molecules. Conclusion. Practical information to the medical profession in order to detect and manage such reactions is provided.