J Korean Med Sci.  2018 Mar;33(12):e87. 10.3346/jkms.2018.33.e87.

Immediate Hypersensitivity Reactions Induced by Triamcinolone in a Patient with Atopic Dermatitis

• Son JH
• Park SY
• Cho YS
• Chung BY
• Kim HO
• Park CW

• KMID: 2406882
• DOI: http://doi.org/10.3346/jkms.2018.33.e87

Abstract

Corticosteroids are potent anti-inflammatory and anti-allergic agents used in the treatment of various inflammatory diseases, including allergic disease. They are frequently considered the therapy-of-choice for many skin diseases. However, allergic reactions caused by corticosteroids have been reported. Among these, delayed reactions to topical steroids are more common, whereas immediate reactions to systemic steroids are rare. Herein, we report the case of a 32-year-old woman with triamcinolone-induced immediate hypersensitivity reaction, in which the patient had a positive prick test result with triamcinolone. She has had atopic dermatitis (AD) for three years. She had used systemic steroid, cyclosporine, and antihistamine with topical steroids for AD. In clinic, approximately 10 minutes after intralesional injection of triamcinolone, she complained of erythematous patches with slight elevation and itching on the face, trunk, and both hands. After intravenous injection of dexamethasone, her symptoms got worse. After treatment with epinephrine, all symptoms resolved within two hours. We performed an open test and skin prick test. She had a positive result only from the prick test with triamcinolone; all other steroids showed negative results from the open tests. Dermatologists should be aware of the possibility of anaphylaxis or other allergic hypersensitivity in response to corticosteroids.

Keyword

Steroid; Hypersensitivity; Skin Prick Test; Open Test

MeSH Terms

Adrenal Cortex Hormones
Adult
Anaphylaxis
Anti-Allergic Agents
Cyclosporine
Dermatitis, Atopic*
Dexamethasone
Epinephrine
Female
Hand
Humans
Hypersensitivity
Hypersensitivity, Immediate*
Injections, Intralesional
Injections, Intravenous
Pruritus
Skin
Skin Diseases
Steroids
Triamcinolone*
Adrenal Cortex Hormones
Anti-Allergic Agents
Cyclosporine
Dexamethasone
Epinephrine
Steroids
Triamcinolone

Figure

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  Fig. 2 Skin prick tests (SPTs) and topical provocation test were done and we observed the results every 15 minutes. (A) SPTs showed positive reaction to triamcinolone, but not to other steroids, after 30 minutes. (B) All steroids showed negative results for an open test after 30 minutes.1 = hydrocortisone, 2 = mometasone furoate, 3 = prednicarbate, 4 = desonide, 5 = desoxymethasone, 6 = prednisolone valerate, 7 = triamcinolone acetonide, 8 = clobetasol propionate, 9 = methylprednisolone, 10 = prednisolone, TCN = triamcinolone acetonide, DX = dexamethasone, PIP = piprinhydrinate.

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