Asia Pac Allergy.  2017 Apr;7(2):115-118. 10.5415/apallergy.2017.7.2.115.

Anaphylaxis following intralesional triamcinolone acetonide (Kenacort) injection

• Laisuan W
• Wongsa C
• Dchapaphapeaktak N
• Tongdee M
• Chatmapanrangsee J
• Rerkpattanapipat T

• KMID: 2396933
• DOI: http://doi.org/10.5415/apallergy.2017.7.2.115

Abstract

Intralesional triamcinolone acetonide injection is indicated for multiple skin conditions such as keloid scars, alopecia areata, and hypertrophic lichen planus. Immediate hypersensitivity reaction remains uncommon. We report on a 24-year-old woman who had received multiple intralesional injections with triamcinolone acetonide (Kenacort) plus lidocaine for keloid scar treatment without any reaction for the previous 10 years. The immediate reaction occurred 15 minutes after injection, with numbness on her face and 5 minutes later with urticaria on her chest wall and upper extremities, together with hypotension (blood pressure of 90/60 mmHg). Allergology workup revealed positive skin prick test for triamcinolone acetonide (Kenacort). Skin tests for other corticosteroids (hydrocortisone, methylprednisolone, and dexamethasone), excipients (carboxymethylcellulose, benzyl alcohol, and polysorbate 80) and lidocaine were negative, including subcutaneous challenge for lidocaine and oral challenge for carboxymethylcellulose. IgE-mediated hypersensitivity reaction must be considered in cases of multiple applications of triamcinolone acetonide injection.

Keyword

Anaphylaxis; Anaphylactic shock; Drug hypersensitivity; Drug allergy; Hypersensitivity, Immediate

MeSH Terms

Adrenal Cortex Hormones
Alopecia Areata
Anaphylaxis*
Benzyl Alcohol
Carboxymethylcellulose Sodium
Cicatrix
Drug Hypersensitivity
Excipients
Female
Humans
Hypersensitivity, Immediate
Hypesthesia
Hypotension
Injections, Intralesional
Keloid
Lichen Planus
Lidocaine
Methylprednisolone
Skin
Skin Tests
Thoracic Wall
Triamcinolone Acetonide*
Triamcinolone*
Upper Extremity
Urticaria
Young Adult
Adrenal Cortex Hormones
Benzyl Alcohol
Carboxymethylcellulose Sodium
Excipients
Lidocaine
Methylprednisolone
Triamcinolone
Triamcinolone Acetonide

Figure

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  Fig. 1 Results of the skin prick test.

Reference

1. Venturini M, Lobera T, del Pozo MD, González I, Blasco A. Immediate hypersensitivity to corticosteroids. J Investig Allergol Clin Immunol. 2006; 16:51–56.

2. Kränke B, Aberer W. Skin testing for IgE-mediated drug allergy. Immunol Allergy Clin North Am. 2009; 29:503–516.

3. Jacob SE, Steele T. Corticosteroid classes: a quick reference guide including patch test substances and cross-reactivity. J Am Acad Dermatol. 2006; 54:723–727.

4. Klein-Gitelman MS, Pachman LM. Intravenous corticosteroids: adverse reactions are more variable than expected in children. J Rheumatol. 1998; 25:1995–2002.

5. Nakamura H, Matsuse H, Obase Y, Mitsuta K, Tomari S, Saeki S, Kawano T, Kondo Y, Machida I, Shimoda T, Asai S, Kohno S. Clinical evaluation of anaphylactic reactions to intravenous corticosteroids in adult asthmatics. Respiration. 2002; 69:309–313.

6. 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.

7. Matura M, Goossens A. Contact allergy to corticosteroids. Allergy. 2000; 55:698–704.

8. Fulcher DA, Katelaris CH. Anaphylactoid reaction to intravenous hydrocortisone sodium succinate: a case report and literature review. Med J Aust. 1991; 154:210–214.

9. Lepoittevin JP, Drieghe J, Dooms-Goossens A. Studies in patients with corticosteroid contact allergy. Understanding cross-reactivity among different steroids. Arch Dermatol. 1995; 131:31–37.

10. Isaksson M, Bruze M, Lepoittevin JP, Goossens A. Patch testing with serial dilutions of budesonide, its R and S diastereomers, and potentially cross-reacting substances. Am J Contact Dermat. 2001; 12:170–176.

11. Rao KV, Andersen RC, O'Brien TJ. Successful renal transplantation in a patient with anaphylactic reaction to Solu-Medrol (methylprednisolone sodium succinate). Am J Med. 1982; 72:161–163.

12. Baeck M, Chemelle JA, Goossens A, Nicolas JF, Terreux R. Corticosteroid cross-reactivity: clinical and molecular modelling tools. Allergy. 2011; 66:1367–1374.

13. Baeck M, Chemelle JA, Rasse C, Terreux R, Goossens A. C(16)-methyl corticosteroids are far less allergenic than the non-methylated molecules. Contact Dermatitis. 2011; 64:305–312.

14. Baeck M, Goossens A. Immediate and delayed allergic hypersensitivity to corticosteroids: practical guidelines. Contact Dermatitis. 2012; 66:38–45.

15. Karsh J, Yang WH. An anaphylactic reaction to intra-articular triamcinolone: a case report and review of the literature. Ann Allergy Asthma Immunol. 2003; 90:254–258.

16. 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.

17. Bigliardi PL, Izakovic J, Weber JM, Bircher AJ. Anaphylaxis to the carbohydrate carboxymethylcellulose in parenteral corticosteroid preparations. Dermatology. 2003; 207:100–103.

18. Baker A, Empson M, The R, Fitzharris P. Skin testing for immediate hypersensitivity to corticosteroids: a case series and literature review. Clin Exp Allergy. 2015; 45:669–676.