Allergy Asthma Immunol Res.  2011 Oct;3(4):277-279. 10.4168/aair.2011.3.4.277.

Acute Urticaria Induced by Oral Methylprednisolone

• Jang EJ
• Jin HJ
• Nam YH
• Kim JH
• Ye YM
• Park HS

• KMID: 2167080
• DOI: http://doi.org/10.4168/aair.2011.3.4.277

Abstract

Although corticosteroids have immunosuppressive, anti-inflammatory, and anti-allergic effects, allergic reactions are rare. We report a case involving a 52-year-old-female with acute urticaria caused by oral methylprednisolone. The patient had experienced aspirin-exacerbated respiratory disease (AERD) for 13 years with frequent asthma exacerbations. Symptoms of asthma exacerbations improved with short-term treatments of systemic steroids, including methylprednisolone or deflazacort, which had been well tolerated. However, the current admission was prompted by the development of acute generalized urticaria following the oral ingestion of methylprednisolone (8 mg) for relief of symptoms. An oral provocation test with 4 mg oral methylprednisolone led to generalized urticaria 20 minutes later, confirming the causal association. This is the first report of acute urticaria caused by oral methylprednisolone in a patient with AERD.

Keyword

Drug hypersensitivity; methylprednisolone; urticaria

MeSH Terms

Adrenal Cortex Hormones
Asthma
Drug Hypersensitivity
Eating
Humans
Hypersensitivity
Methylprednisolone
Pregnenediones
Steroids
Urticaria
Adrenal Cortex Hormones
Methylprednisolone
Pregnenediones
Steroids

Figure

• 

  Figure Generalized urticaria that developed after 20 min of oral methylprednisolone exposure. (A) Photograph of the reaction on an ankle. (B) Photograph of the reaction in the lower extremities.

Reference

1. Ventura MT, Muratore L, Calogiuri GF, Dagnello M, Buquicchio R, Nicoletti A, Altamura M, Sabbà C, Tursi A. Allergic and pseudoallergic reactions induced by glucocorticoids: a review. Curr Pharm Des. 2003. 9:1956–1964.

2. Ramirez R, Brancaccio RR. Allergic cutaneous reactions to systemic corticosteroids. An Bras Dermatol. 2007. 82:169–176.

3. Dooms-Goossens A, Andersen KE, Brandäo FM, Bruynzeel D, Burrows D, Camarasa J, Ducombs G, Frosch P, Hannuksela M, Lachapelle JM, Lahti A, Menné T, Wahlberg JE, Wilkinson JD. Corticosteroid contact allergy: an EECDRG multicentre study. Contact Dermatitis. 1996. 35:40–44.

4. Borja JM, Galindo PA, Feo F, Gomez E. Urticaria to methylprednisolone sodium hemisuccinate. Allergy. 2001. 56:791.

5. Kilpiö K, Hannuksela M. Corticosteroid allergy in asthma. Allergy. 2003. 58:1131–1135.

6. Dajani BM, Sliman NA, Shubair KS, Hamzeh YS. Bronchospasm caused by intravenous hydrocortisone sodium succinate (Solu-Cortef) in aspirin-sensitive asthmatics. J Allergy Clin Immunol. 1981. 68:201–204.

7. Szczeklik A, Nizankowska E, Czerniawska-Mysik G, Sek S. Hydrocortisone and airflow impairment in aspirin-induced asthma. J Allergy Clin Immunol. 1985. 76:530–536.

8. Feigenbaum BA, Stevenson DD, Simon RA. Hydrocortisone sodium succinate does not cross-react with aspirin in aspirin-sensitive patients with asthma. J Allergy Clin Immunol. 1995. 96:545–548.

9. Pryse-Phillips WE, Chandra RK, Rose B. Anaphylactoid reaction to methylprednisolone pulsed therapy for multiple sclerosis. Neurology. 1984. 34:1119–1121.

10. Freedman MD, Schocket AL, Chapel N, Gerber JG. Anaphylaxis after intravenous methylprednisolone administration. JAMA. 1981. 245:607–608.

11. Kamm GL, Hagmeyer KO. Allergic-type reactions to corticosteroids. Ann Pharmacother. 1999. 33:451–460.

12. Patterson DL, Yunginger JW, Dunn WF, Jones RT, Hunt LW. Anaphylaxis induced by the carboxymethylcellulose component of injectable triamcinolone acetonide suspension (Kenalog). Ann Allergy Asthma Immunol. 1995. 74:163–166.

13. Montoro J, Valero A, Elices A, Rubira N, Serra-Baldrich E, Amat P, Malet A. Anaphylactic shock after intra-articular injection of carboxymethylcellulose. Allergol Immunopathol (Madr). 2000. 28:332–333.

14. 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.