Skip to main content

Advertisement

SpringerLink
Log in

The Impact of Corticosteroid Allergy

  • Contact Dermatitis (S Jacob, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion statement

The key to treatment of corticosteroid allergy, especially delayed-type reactions to topical corticosteroids, is in recognizing it as a possible diagnosis. Corticosteroids are among the most important anti-inflammatory agents in a physician’s therapeutic armamentarium; these medications are the cornerstone of treatment for most dermatoses and may be overlooked as the culprit in cases of refractory dermatitis. Clues to possible corticosteroid allergy include persistence or worsening of dermatitis with the use of an appropriate agent or a change in the clinical pattern of disease. Patients may neglect to mention use of over-the-counter topical corticosteroid use; the possibility of corticosteroid contact allergy is more likely in those with chronic dermatoses such as atopic or stasis dermatitis. Once suspected, corticosteroid allergy can be confirmed by a repeat open application test (ROAT) with the suspect medicament agent in addition to standard patch testing. Patch testing techniques that may improve diagnostic accuracy include testing to agents from all classes, performing a late (7–10-day) reading, and considering “rim reactions” as likely relevant. Once the patient’s allergy is known, the clinician can choose a safe alternative. To minimize the risk of inducing corticosteroid allergy, physicians should consider prescribing agents that are less allergenic, e.g., those in classes C or D1, especially for patients with chronic skin disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kligman AM. The identification of contact allergens by human assay. II. Factors influencing the induction and measurement of allergic contact dermatitis. J Invest Dermatol. 1966;47:375–92.

    Article  CAS  PubMed  Google Scholar 

  2. Matura G. Contact allergy to corticosteroids. Allergy. 2000;55:698–704.This article expands upon our understanding of corticosteroid cross-reactivity and proposes the subdivision of group D into D1 and D2.

  3. Patel A, Bahna S. Immediate hypersensitivity reactions to corticosteroids. Ann Allergy Asthma Immunol. 2015;115:178–82.This article summarizes all recent cases of immediate hypersensitivity reactions to corticosteroids to characterize the epidemiology, clinical scenarios, diagnosis, and management.

    Article  CAS  PubMed  Google Scholar 

  4. Kim SH, Kim HY. Anaphylaxis induced by oral methylprednisolone in a 10-year-old boy. Pediatr Int. 2014;56(5):783–4.

    Article  PubMed  Google Scholar 

  5. Borja JM et al. Urticaria to methylprednisolone sodium hemisuccinate. Allergy. 2001;56:791.

    Article  CAS  PubMed  Google Scholar 

  6. Ventura MT, Sanapo F, Calogluri GF, Satriano F. Anaphylaxis induced by intramuscular betamethasone disodium phosphate: reflections on a clinical case. Int J Immunopathol Pharmacol. 2007;20(2):387–91.

    CAS  PubMed  Google Scholar 

  7. LaBerge L, Pratt M. Immediate and delayed hypersensitivity to systemic corticosteroids: 2 case reports. Dermatitis. 2012;23(6):288–90.

    Article  CAS  PubMed  Google Scholar 

  8. Kamm GL, Hagmever KO. Allergic-type reactions to corticosteroids. Ann Pharmacother. 1999;33:451–60.

    Article  CAS  PubMed  Google Scholar 

  9. Rachid R, Leslie D, Schneider L, Twarog F. Hypersensitivity to systemic corticosteroids: an infrequent but potentially life-threatening condition. J Allergy Clin Immunol. 2011;127:524–8.

    Article  PubMed  Google Scholar 

  10. Angel-Pereira D, Berges-Gimeno MP, Madrigal-Burgaleta R, Ureña-Tavera MA, Zamora-Verduga M, E. A-C. Successful rapid desensitization to methylprednisolone sodium hemisuccinate: a case report. J Allergy Clin Immunol Pract. 2014;2(3):346–8.

    Article  PubMed  Google Scholar 

  11. Macy E. Practical management of patients with a history of immediate hypersensitivity to common non beta-lactam drugs. Curr Allergy Asthma Rep. 2016;1:4.

    Article  Google Scholar 

  12. Thompson T, Belsito R. Reagional variation in prevalence and etiology of allergic contact dermatitis. Am J Contact Dermatol. 2002;13(4):177–82.

    Article  Google Scholar 

  13. Vind-Kezunovic D et al. Prevalence of and factors influencing sensitization to corticosteroids in a Danish patch test population. Contact Dermatitis. 2011;64(6):325–9.

    Article  CAS  PubMed  Google Scholar 

  14. Wattanakrai P, Bhakinai T, Pootongkam S. Pattern of corticosteroid allergy in Thailand. Dermatitis. 2010;21(4):203–6.

    PubMed  Google Scholar 

  15. Baeck M, De Potter P, J. GA. Allergic contact dermatitis following ocular use of corticosteroids. Ocul Pharmacol Ther. 2011;27(1):83–92.

    Article  CAS  Google Scholar 

  16. Baeck M et al. Allergic contact dermatitis to inhalation corticosteroids. Eur J Dermatol. 2010;20(1):102–8.

    CAS  PubMed  Google Scholar 

  17. Bennett ML, Fountain JM, McCarty MA, Sheretz EF. Contact allergy to corticosteroids in patients using inhaled or intranasal corticosteroids for allergic rhinitis or asthma. Am J Contact Dermat. 2001;12(4):193–6.

    CAS  PubMed  Google Scholar 

  18. Amin N, Brancaccio R, Cohen D. Cutaneous reactions to injectable corticosteroids. Dermatitis. 2006;17(3):143–6.

    Article  PubMed  Google Scholar 

  19. Baeck M, Goossens A. Systemic contact dermatitis to corticosteroids. Allergy. 2012;67(12):1580–5.

    CAS  PubMed  Google Scholar 

  20. Fowler JF. Contact allergy to hydrocortisone and systemic contact dermatitis from prednisolone with tolerance of betamethasone. Am J Contact Dermat. 1998;19(2):136–8.

    Google Scholar 

  21. Kot M, Bogaczewicz J, Krecisz B, Wozniacka A. Contact hypersensitivity to haptens of the European standard series and corticosteroid series in the population of adolescents and adults with atopic dermatitis. Dermatitis. 2014;24(2):72–6.

    Article  Google Scholar 

  22. Barbaud et al. Contact allergy in chronic leg ulcers: results of a multicenter study carried out in 423 patients and proposal of an updated series of patch tests. Contact Dermatitis. 2009;60(5):289–7.

    Article  Google Scholar 

  23. Coloe J, Zirwas MJ. Allergens in corticosteroid vehicles. Dermatitis. 2008;19(1):38–42.

    PubMed  Google Scholar 

  24. Coopman S, Degreef H, Dooms-Goossens A. Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids. Br J Dermatol. 1989;121:27–34.This article proposes the original classification of corticosteroids based on cross-reactivity patterns.

  25. Baeck M, Chemelle JA, Goossens A, Nicolas JF. Terreux R. Corticosteroid cross-reactivity: clinical and molecular modeling tools. Allergy. 2011;66(10)):1367–74.This article expands upon our understanding of corticosteroid cross-reactivity and suggests two subsets of patients with allergy.

  26. Baeck M, Chemelle JA, Terreux R, Drieghe J, Goosens AN. Delayed hypersensitivity ot corticosteroids in a series of 315 patients: clinical data and patch test results. Contact Dermatitis. 2009;61:163–75.

    Article  CAS  PubMed  Google Scholar 

  27. Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, Cannavó A, Giménez-Arnau A, Gonçalo M, Goossens A, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis. 2015;73(4):195–221.

    Article  PubMed  Google Scholar 

  28. Boffa MJ et al. Screening for corticosteroid contact hypersensitivity. Contact Dermatitis. 1995;33:149–51.

    Article  CAS  PubMed  Google Scholar 

  29. Davis MDP, Farmer S. Results of patch testing to a corticosteroid series: experience with 1000 patients at Mayo Clinic. [abstract]. Dermatitis. 2006;17(2):102–3.

    Article  Google Scholar 

  30. Davis MDP, Richardson DM, Farmer SA. Low yield for extended reading of patch tests with topical steroids. Dermatitis. 2005;16(3):124–6.

    PubMed  Google Scholar 

  31. Bjarnason B, Flosadóttir E, Fischer T. Reactivity at edges of corticosteroid patch tests may be an indicator of a strong positive test response. Dermatology. 1999;199(2):130–4.

    Article  CAS  PubMed  Google Scholar 

  32. Herbst RA, Lauerma AI, Maibach HI. Intradermal testing in the diagnosis of allergic contact dermatitis. Contact Dermatitis. 1993;29(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  33. Mimesh S, Pratt M. Allergic contact dermatitis from corticosteroids: reproducibility of patch testing and correlation with intradermal testing. Dermatitis. 2006;17(3):137–42.

    Article  PubMed  Google Scholar 

  34. Soni BP, Sherertz EF. Evaluation of previously patch-tested patients referred to a contact dermatitis clinic. Am J Contact Dermat. 1997;8(1):10–4.

    CAS  PubMed  Google Scholar 

  35. White JM, McFadden JP, White IR. A review of 241 subjects who were patch tested twice: could fragrance mix I cause active sensitization? Br J Dermatol. 2008;158(3):518–21.

    Article  CAS  PubMed  Google Scholar 

  36. Hannuksela M, Salo H. The repeated open application test (ROAT). Contact Dermatitis. 1986;14(4):221–7.

    Article  CAS  PubMed  Google Scholar 

  37. Donovan JCH, DeKoven JG. Cross-reactions to desoximetasone and mometasone furoate in a patient with multiple topical corticosteroid allergies. Dermatitis. 2006;17(3):147–51.

    Article  PubMed  Google Scholar 

  38. Katsarou A, Makris M, Papagiannaki K, Lagogianni E, Tagka A, Kalogeromitros D. Tacrolimus 0.1 % vs mometasone furoate topical treatment in allergic contact hand eczema: a prospective randomized clinical study. Eur J Dermatol. 2012;22(2):192–6.

    CAS  PubMed  Google Scholar 

  39. Ho N, Pope E, Weinstein M, Greenberg S, Webster C, Krafchik BR. A double-blind, randomized, placebo-controlled trial of topical tacrolimus 0.1 % vs. clobetasol propionate 0.05 % in childhood vitiligo. Br J Dermatol. 2011;165(3):626–32.

    Article  CAS  PubMed  Google Scholar 

  40. Freymond N, Catelain A, Queille E, Augey F, Nicolas JF. Allergic reaction to methylprednisolone. Rev Med Interne. 2003;24:698–700.

    Article  CAS  PubMed  Google Scholar 

  41. Baeck M, Goosens A. Immediate and delayed allergic hypersensitivity to corticosteroids: practical guidelines. Contact Dermatitis. 2011;66:38–45.

    Article  PubMed  Google Scholar 

  42. Hajar T, YA L, JM H, ST N, PA L, AS P, Block J, EL S. The National Eczema Association Task Force). A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541-549.e2.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA

    Sara Harcharik Perkins MD, Christopher R. Stamey MD & Kalman L. Watsky MD

Authors
  1. Sara Harcharik Perkins MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher R. Stamey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kalman L. Watsky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kalman L. Watsky MD.

Ethics declarations

Conflict of Interest

Dr. Sara Harcharik Perkins declare that they have no conflict of interest.

Dr. Christopher R Stamey declare that they have no conflict of interest.

Dr. Kalman L. Watsky edits a section on Prurigo Nodularis for UpToDate.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Contact Dermatitis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perkins, S.H., Stamey, C.R. & Watsky, K.L. The Impact of Corticosteroid Allergy. Curr Treat Options Allergy 3, 333–344 (2016). https://doi.org/10.1007/s40521-016-0089-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-016-0089-x

Keywords

Search

Navigation