Dissertations

Total Page:16

File Type:pdf, Size:1020Kb

Dissertations Dissertations Clinical and Experimen- tal Studies in Cortico- steroid Contact Allergy Marléne Isaksson Department of Occupational and Environmental Dermatology, Malmö University Hospital, S - 205 02 Malmö, Sweden. Tel: +46-40 337859. Fax: +46- 40 336213. marlene.isaksson@ derm.mas.lu.se. Corticosteroids are anti-inflammatory and anti-proliferative substances that also can induce sensitization, mainly through skin contact. In a sensitized individual, it can be hard to disclose Marléne Isaksson (middle) defended her thesis on April 14th, 2000 at the University Hospital, the contact allergy at patch testing Malmö, Sweden. Faculty Opponent was Antti I Lauerma (right), Skin and Allergy Hospital, Helsinki, Finland and supervisor was Magnus Bruze (left), University Hospital, Malmö, Sweden. because the anti-inflammatory effect may mask the allergic contact reac- tion. This is primarily seen when patch testing to potent corti- mended concentration gave negative The edge reaction, consisting of a costeroids is performed and the reactions. If testing with a corti- blank centre representing the whole reading is done early, when the anti- costeroid at a high concentration area of the test unit and surrounded inflammatory effect still prevails. results in a negative patch-test by an eczematous infiltrate, is seen reaction, lowering the concentration in some corticosteroid allergic A hypothetical model is presented, may result in a positive patch-test patients when potent corticosteroids which can explain the different reaction. are patch-tested. This phenomenon situations that emerge, when the anti- can also be explained by the same model. If an edge reaction appears, a inflammatory effect influences the Introducing another parameter into late reading or testing with a lower elicitation depending on the indivi- the model, the time factor, made it concentration should be done. dual degree of hypersensitivity in a possible also to explain why negative sensitized subject. patch test reactions are sometimes seen at early readings, while the tests The cross-reactivity pattern for the Some patients allergic to the corti- may turn positive on late reading two diastereomers of budesonide, the costeroid budesonide only reacted to occasions. Therefore, not to miss R and S diastereomers, was also very low concentrations of the sensiti- contact allergy to corticosteroids, a investigated. Results concurred with zer at early readings. When patch reading after one week in addition to the theory that the R diastereomer testing the corticosteroid triamcino- an early reading is advocated. The cross-reacts with other substances lone acetonide, concentrations 1,000 multicentre study showed that 25% of from the group to which it belongs, to 10,000 times lower than interna- the allergic reactions to cortico- group B, while the S diastereomer tionally recommended resulted in steroids would have been missed if a cross-reacts not only with other group allergic reactions while the recom- late reading had not been done. B substances but also with some esters of group D. Forum for Nord Derm Ven Vol. 6 February 2001 16 No inhibition of the patch test reac- stable for at least one year in room Key words: corticosteroids, allergic tions was observed when patch temperature, refrigerated and frozen. contact dermatitis, budesonide, testing the corticosteroid tixocortol Budesonide and tixocortol pivalate in tixocortol pivalate, hydrocortisone- pivalate and potentially cross-reacting ethanol showed the same stability. Hc- 17-butyrate, dose-response relation- substances at high concentrations. 17-B 1.0% in ethanol was only stable ship, mixes, stability, clinical relevan- frozen for one year and at room ce, ROAT, inhalation. temperature for three months. Aldehydes of corticosteroids are thought to be intermediates in the List of original publications sensitization process. The aldehyde of In the study on local clinical relevance, hydrocortisone was therefore tested the flare-up reactions in the budeso- I. Isaksson M, Bruze M, Goossens A, Lepoittevin J-P. Patch testing with in subjects allergic to hydrocortisone. nide-allergic individuals consisted not budesonide in serial dilutions: the Patients reacting to hydrocortisone only of a severe deterioration of the significance of dose, occlusion time also reacted to the aldehyde, speaking Preferid® treated eczema but also and reading time. Contact Dermatitis 1999; 40: 24–31. in favour of the aldehyde being an toxicoderma-like eruptions with a II. Isaksson M, Bruze M, Goossens A, intermediate in the sensitization. conspicuous distribution. A correla- Lepoittevin J-P. Patch-testing with tion was found between contact serial dilutions of tixocortol pivalate allergy to budesonide and deteriora- and potential cross-reactive substan- When trying to elucidate whether a ces. Acta Derm Venereol 2000; 80: 33– tion of the eczema treated with corticosteroid mix, consisting of the 38. Preferid® cream containing budesoni- three corticosteroids budesonide, III. Isaksson M, Andersen KE, Brandão FM, de. Bruynzeel DP, Bruze M, Camarasa JG, tixocortol pivalate and hydrocorti- Diepgen T, Ducombs G, Frosch PJ, sone-17-butyrate (Hc-17-B) in petrola- Goossens A, Lahti A, Menné T, Rycroft tum, could disclose corticosteroid To study flare-up reactions at earlier RJG, Seidenari S, Shaw S, Tosti A, Wahlberg JE, White IR, Wilkinson JD. allergy, it was found that 60% of the budesonide test sites a systemic Patch testing with corticosteroid mixes patients allergic to tixocortol pivalate provocation with Pulmicort® Turbu- in Europe. A Multicentre Study of the were missed. Thus, in a corticosteroid haler® (budesonide) via inhalation was EECDRG. Contact Dermatitis 2000; 42: mix containing budesonide and Hc- performed in subjects allergic to 27–35. IV. Isaksson M, Gruvberger B, Persson L, 17-B, tixocortol pivalate should not be budesonide but without asthma or Bruze M. Stability of corticosteroid a part. Of the separate markers that other lung dysfunction. The study patch test preparations. Contact were patch-tested simultaneously in clearly showed that flare-up reactions Dermatitis 2000; 42: 144–148. petrolatum, budesonide 0.10% detect- were found after normal doses of V. Isaksson M, Bruze M, Goossens A, Lepoittevin J-P. Patch testing with ed most allergic subjects, followed by budesonide. Therefore, a person serial dilutions of budesonide, its R budesonide 0.002% and tixocortol hypersensitive to budesonide should and S diastereomers, and potentially pivalate, both concentrations (1.0% not be given the drug as an inhalant. cross-reacting substances. Submitted. and 0.10%) detecting the same num- In the same study a new method in VI. Isaksson M, Bruze M. ROAT with budesonide on experimental allergic ber of patients. Hc-17-B at 1.0% humans to test for cross-sensitivity contact dermatitis from nickel in detected more than 0.10%. was used. When budesonide was individuals hypersensitive to budeso- inhaled, a flare-up was noted where nide. Submitted. VII. Isaksson M, Bruze M. Allergic contact triamcinolone acetonide had been Investigations on the stability of dermatitis to budesonide reactivated tested previously, indicating cross- budesonide, tixocortol pivalate and by inhalation of the allergen. Sub- reactivity between budesonide and mitted. Hc-17-B patch-test preparations in triamcinolone acetonide. petrolatum disclosed that these were Forum for Nord Derm Ven Vol. 6 February 2001 17.
Recommended publications
  • Steroid Use in Prednisone Allergy Abby Shuck, Pharmd Candidate
    Steroid Use in Prednisone Allergy Abby Shuck, PharmD candidate 2015 University of Findlay If a patient has an allergy to prednisone and methylprednisolone, what (if any) other corticosteroid can the patient use to avoid an allergic reaction? Corticosteroids very rarely cause allergic reactions in patients that receive them. Since corticosteroids are typically used to treat severe allergic reactions and anaphylaxis, it seems unlikely that these drugs could actually induce an allergic reaction of their own. However, between 0.5-5% of people have reported any sort of reaction to a corticosteroid that they have received.1 Corticosteroids can cause anything from minor skin irritations to full blown anaphylactic shock. Worsening of allergic symptoms during corticosteroid treatment may not always mean that the patient has failed treatment, although it may appear to be so.2,3 There are essentially four classes of corticosteroids: Class A, hydrocortisone-type, Class B, triamcinolone acetonide type, Class C, betamethasone type, and Class D, hydrocortisone-17-butyrate and clobetasone-17-butyrate type. Major* corticosteroids in Class A include cortisone, hydrocortisone, methylprednisolone, prednisolone, and prednisone. Major* corticosteroids in Class B include budesonide, fluocinolone, and triamcinolone. Major* corticosteroids in Class C include beclomethasone and dexamethasone. Finally, major* corticosteroids in Class D include betamethasone, fluticasone, and mometasone.4,5 Class D was later subdivided into Class D1 and D2 depending on the presence or 5,6 absence of a C16 methyl substitution and/or halogenation on C9 of the steroid B-ring. It is often hard to determine what exactly a patient is allergic to if they experience a reaction to a corticosteroid.
    [Show full text]
  • Contact Dermatitis to Medications and Skin Products
    Clinical Reviews in Allergy & Immunology (2019) 56:41–59 https://doi.org/10.1007/s12016-018-8705-0 Contact Dermatitis to Medications and Skin Products Henry L. Nguyen1 & James A. Yiannias2 Published online: 25 August 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Consumer products and topical medications today contain many allergens that can cause a reaction on the skin known as allergic contact dermatitis. This review looks at various allergens in these products and reports current allergic contact dermatitis incidence and trends in North America, Europe, and Asia. First, medication contact allergy to corticosteroids will be discussed along with its five structural classes (A, B, C, D1, D2) and their steroid test compounds (tixocortol-21-pivalate, triamcinolone acetonide, budesonide, clobetasol-17-propionate, hydrocortisone-17-butyrate). Cross-reactivities between the steroid classes will also be examined. Next, estrogen and testosterone transdermal therapeutic systems, local anesthetic (benzocaine, lidocaine, pramoxine, dyclonine) antihistamines (piperazine, ethanolamine, propylamine, phenothiazine, piperidine, and pyrrolidine), top- ical antibiotics (neomycin, spectinomycin, bacitracin, mupirocin), and sunscreen are evaluated for their potential to cause contact dermatitis and cross-reactivities. Finally, we examine the ingredients in the excipients of these products, such as the formaldehyde releasers (quaternium-15, 2-bromo-2-nitropropane-1,3 diol, diazolidinyl urea, imidazolidinyl urea, DMDM hydantoin), the non- formaldehyde releasers (isothiazolinones, parabens, methyldibromo glutaronitrile, iodopropynyl butylcarbamate, and thimero- sal), fragrance mixes, and Myroxylon pereirae (Balsam of Peru) for contact allergy incidence and prevalence. Furthermore, strategies, recommendations, and two online tools (SkinSAFE and the Contact Allergen Management Program) on how to avoid these allergens in commercial skin care products will be discussed at the end.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2009/0099225A1 Freund Et Al
    US 20090099225A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2009/0099225A1 Freund et al. (43) Pub. Date: Apr. 16, 2009 (54) METHOD FOR THE PRODUCTION OF Related U.S. Application Data PROPELLANT GAS-FREE AEROSOLS FROM (63) Continuation of application No. 1 1/506,128, filed on AQUEOUSMEDICAMENT PREPARATIONS Aug. 17, 2006, now Pat. No. 7,470,422, which is a continuation of application No. 10/417.766, filed on (75) Inventors: Bernhard Freund, Gau-Algesheim Apr. 17, 2003, now abandoned, which is a continuation (DE); Bernd Zierenberg, Bingen of application No. 09/331,023, filed on Sep. 15, 1999, am Rhein (DE) now abandoned. (30) Foreign Application Priority Data Correspondence Address: MICHAEL P. MORRIS Dec. 20, 1996 (DE) ............................... 19653969.2 BOEHRINGERINGELHEMI USA CORPORA Dec. 16, 1997 (EP) ......................... PCT/EP97/07062 TION Publication Classification 900 RIDGEBURY RD, P. O. BOX 368 RIDGEFIELD, CT 06877-0368 (US) (51) Int. Cl. A63L/46 (2006.01) (73) Assignee: Boehringer Ingelheim Pharma A63L/437 (2006.01) KG, Ingelheim (DE) (52) U.S. Cl. ......................................... 514/291; 514/299 (57) ABSTRACT (21) Appl. No.: 12/338,812 The present invention relates to pharmaceutical preparations in the form of aqueous solutions for the production of propel (22) Filed: Dec. 18, 2008 lant-free aerosols. US 2009/0099225A1 Apr. 16, 2009 METHOD FOR THE PRODUCTION OF 0008 All substances which are suitable for application by PROPELLANT GAS-FREE AEROSOLS FROM inhalation and which are soluble in the specified solvent can AQUEOUSMEDICAMENT PREPARATIONS be used as pharmaceuticals in the new preparations. Pharma ceuticals for the treatment of diseases of the respiratory pas RELATED APPLICATIONS sages are of especial interest.
    [Show full text]
  • Wo 2008/127291 A2
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (43) International Publication Date PCT (10) International Publication Number 23 October 2008 (23.10.2008) WO 2008/127291 A2 (51) International Patent Classification: Jeffrey, J. [US/US]; 106 Glenview Drive, Los Alamos, GOlN 33/53 (2006.01) GOlN 33/68 (2006.01) NM 87544 (US). HARRIS, Michael, N. [US/US]; 295 GOlN 21/76 (2006.01) GOlN 23/223 (2006.01) Kilby Avenue, Los Alamos, NM 87544 (US). BURRELL, Anthony, K. [NZ/US]; 2431 Canyon Glen, Los Alamos, (21) International Application Number: NM 87544 (US). PCT/US2007/021888 (74) Agents: COTTRELL, Bruce, H. et al.; Los Alamos (22) International Filing Date: 10 October 2007 (10.10.2007) National Laboratory, LGTP, MS A187, Los Alamos, NM 87545 (US). (25) Filing Language: English (81) Designated States (unless otherwise indicated, for every (26) Publication Language: English kind of national protection available): AE, AG, AL, AM, AT,AU, AZ, BA, BB, BG, BH, BR, BW, BY,BZ, CA, CH, (30) Priority Data: CN, CO, CR, CU, CZ, DE, DK, DM, DO, DZ, EC, EE, EG, 60/850,594 10 October 2006 (10.10.2006) US ES, FI, GB, GD, GE, GH, GM, GT, HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, KR, KZ, LA, LC, LK, (71) Applicants (for all designated States except US): LOS LR, LS, LT, LU, LY,MA, MD, ME, MG, MK, MN, MW, ALAMOS NATIONAL SECURITY,LLC [US/US]; Los MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PG, PH, PL, Alamos National Laboratory, Lc/ip, Ms A187, Los Alamos, PT, RO, RS, RU, SC, SD, SE, SG, SK, SL, SM, SV, SY, NM 87545 (US).
    [Show full text]
  • Patient Information
    Patient Information Tixocortol Pivalate Your TRUE TEST ® indicates that you have a contact allergy to Tixocortol Pivalate. Tixocortol pivalate and some related compounds in contact with your skin may result in dermatitis. Where is Tixocortol Pivalate found? Tixocortol pivalate is an anti-inflammatory agent that may be found in buccal, nasal, throat and rectal preparations, but not in topical medications for the treatment of skin diseases. Tixocortol pivalate is a marker for a specific class of corticosteroids used to treat skin inflammation. How to avoid Tixocortol Pivalate Avoid pharmaceuticals containing Tixocortol pivalate and other cross-reacting corticosteroids. Pharmaceuticals including corticosteroids are ingredient labeled. If you are strongly allergic a small amount of tixocortol pivalate in contact with your skin may cause an eczematous reaction, usually within 24 hours, that lasts for about a week. If you are weakly allergic the anti-inflammatory effect of tixocortol pivalate may mask the eczema and your skin will not heal. Pharmaceuticals used systemically such as tablets, inhalations and injections may also cause a skin reaction. Inform your healthcare providers that you are allergic to tixocortol pivalate and ask that they use products that are free of this allergen. 2012 ©SmartPractice Denmark Page 1 of 2 Other substances to which you may react o Hydrocortisone o Hydrocortisone acetate o Prednisolone o Prednisolone acetate o Fludrocortisone acetate o Methylprednisolone o Cloprednol You may also react to substances like: o Hydrocortisone-17-butyrate o Hydrocortisone-17-aceponate o Hydrocortisone-17-buteprate o Methylprednisolone aceponate o Prednicarbate A complementary test may be necessary to indicate your specific steroid intolerance.
    [Show full text]
  • Multiple Corticosteroid Orally Elicited Allergic Contact Dermatitis in A
    Multiple Corticosteroid Orally Elicited Allergic Contact Dermatitis in a Patient With Multiple Topical Corticosteroid Allergic Contact Dermatitis Ai-Lean Chew, MBChB, San Francisco, California Howard I. Maibach, MD, San Francisco, California Corticoid allergic contact dermatitis (ACD) may be llergic contact dermatitis (ACD) to topical topically or systemically elicited. Allergic contact corticosteroids is relatively common, having dermatitis to topical corticosteroids is relatively been reported in frequencies of 2.3 to 4.9% in A 1-5 common, whereas reports of orally elicited ACD to recent studies involving many patch-tested patients. corticosteroids are rarer. Patients allergic to one Patients allergic to one topical corticosteroid often corticosteroid often exhibit cross-reactivity to other exhibit cross-reactivity to other topical corticoids. corticoids. We have previously reported a 46-year- Corticosteroids may also sensitize subjects when used old woman with contact allergy documented by orally, parenterally, or intralesionally, although these patch and provocative use testing to multiple top- modes of sensitization are presumed less common. Re- ical corticosteroids. On further testing, she was actions to ingested, parenteral, or intralesional corti- thought to have multiple corticoid orally elicited coids usually occur in patients previously sensitized ACD to triamcinolone, methyl prednisolone, dex- by percutaneous absorption of a topically applied cor- amethasone, and prednisone. Oral provocation ticoid. Lauerma et al6 documented this phenomenon: tests were performed in a single-blind fashion fol- four patients who had known ACD to topical group lowing the method of Alanko and Kauppinen [Di- A corticosteroids all experienced cutaneous reactions agnosis of drug eruptions: clinical evaluation and following administration of oral hydrocortisone.
    [Show full text]
  • 3-6 July 2017 PRAC Meeting Minutes
    1 September 2017 EMA/PRAC/631448/2017 Inspections, Human Medicines Pharmacovigilance and Committees Division Pharmacovigilance Risk Assessment Committee (PRAC) Minutes for the meeting on 3-6 July 2017 Chair: June Raine – Vice-Chair: Almath Spooner Health and safety information In accordance with the Agency’s health and safety policy, delegates are to be briefed on health, safety and emergency information and procedures prior to the start of the meeting. Disclaimers Some of the information contained in the minutes is considered commercially confidential or sensitive and therefore not disclosed. With regard to intended therapeutic indications or procedure scopes listed against products, it must be noted that these may not reflect the full wording proposed by applicants and may also change during the course of the review. Additional details on some of these procedures will be published in the PRAC meeting highlights once the procedures are finalised. Of note, the minutes are a working document primarily designed for PRAC members and the work the Committee undertakes. Note on access to documents Some documents mentioned in the minutes cannot be released at present following a request for access to documents within the framework of Regulation (EC) No 1049/2001 as they are subject to on- going procedures for which a final decision has not yet been adopted. They will become public when adopted or considered public according to the principles stated in the Agency policy on access to documents (EMA/127362/2006, Rev. 1). 30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5520 Send a question via our website www.ema.europa.eu/contact An agency of the European Union © European Medicines Agency, 2017.
    [Show full text]
  • Contact Allergies in Patients with Leg Ulcers
    CONTACT ALLERGIES IN PATIENTS WITH LEG ULCERS Dissertation Submitted to THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY In fulfilment of the regulations for the award of the degree M.D. DERMATOLOGY, VENEREOLOGY AND LEPROLOGY DEPARTMENT OF DERMATOLOGY, VENEROLOGY AND LEPROLOGY PSG INSTITUTE OF MEDICAL SCIENCE AND RESEARCH THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI, TAMILNADU APRIL 2015 CERTIFICATE This is certify that the thesis entitled “ CONTACT ALLERGIES IN PATIENTS WITH LEG ULCERS” is a bonafide work of DR. REVATHI K. done under the direct guidance and supervision of DR. REENA RAI, MD, in the department of Dermatology, Venereology and Leprology, PSG Institute of Medical Sciences and Research, Coimbatore in fulfillment of the regulations of Dr.MGR Medical University for the award of MD degree in Dermatology, Venereology and Leprology. DR. REENA RAI DR. C. R. SRINIVAS Professor Professor & Head of Dept. Dept. of DVL Dept. of DVL DR.RAMALINGAM Principal DECLARATION I hereby declare that this dissertation entitled “ CONTACT ALLERGIES IN PATIENTS WITH LEG ULCERS”was prepared by me under the direct guidance and supervision of DR. REENA RAI, MD, PSG Institute of Medical Sciences and Research, Coimbatore. The dissertation is submitted to the Tamilnadu Dr.MGR Medical University in fulfillment of the University regulation for the award of MD degree in Dermatology, Venereology and Leprology. This dissertation has not been submitted for the award of any other Degree or Diploma. DR. REVATHI K. CERTIFICATE BY THE GUIDE This is certify that the thesis entitled “ CONTACT ALLERGIES IN PATIENTS WITH LEG ULCERS” is a bonafide work of DR.
    [Show full text]
  • NA61: Tixocortol-21-Pivalate
    the art and science of smart patch testing® NA61: Tixocortol-21-Pivalate CAS#: 55560-96-8 Patient Information What are some products that may contain tixocortol-21-pivalate? Your patch test result indicates that you have a contact allergy to tixocortol-21- • Medications: pivalate. This contact allergy may cause your skin to react when it is exposed to – Creams this substance although it may take several days for the symptoms to appear. – Drops Typical symptoms include redness, swelling, itching, and fluid-filled blisters. – Lotions – Nasal sprays Where is tixocortol-21-pivalate found? – Ointments – Powders Tixocortol-21-pivalate is an anti-inflammatory topical corticosteroid used in – Rectal suspensions the treatment of rhinitis (as a nasal suspension or aerosols), pharyngitis (as • You May Also React to Products That Contain: lozenges), ulcerative colitis (as enema or rectal solution), and oral, inflammatory – Amcinonide conditions (as a suspension or a powder). It is also the principle screening – Budesonide substance for contact allergies to class A steroids. – Cloprednol – Desonide How can you avoid contact with tixocortol-21-pivalate? – Fludrocortisone acetate – Fluocinolone acetonide Avoid products that list any of the following names in the ingredients: – Fluocinonide • Tixocortol 21-pivalate – Flurandrenolide • Tixocortol pivalate – Halcinonide • 11beta,17-Dihydroxy-21-mercaptopregn-4-ene-3,20-dione 21-pivalate – Hydrocortisone • EINECS 259-706-4 – Hydrocortisone 17-butyrate – Hydrocortisone acetate • JO 1016 – Hydrocortisone
    [Show full text]
  • Corticosteroid Addiction and Withdrawal in the Atopic: the Red Burning Skin Syndrome MARVIN J
    Corticosteroid Addiction and Withdrawal in the Atopic: The Red Burning Skin Syndrome MARVIN J. RAPAPORT, MD MARK LEBWOHL, MD e recently reported 100 patients with a tum syndrome,” vulvodynia, anal atrophoderma, chronic eyelid dermatitis that did not resolve chronic actinic dermatitis, and “chronic eczema” in until all topical and systemic corticosteroids other body areas (Table 1). These conditions similarly W 1 had been discontinued. All of these patients had been resolved upon discontinuation of corticosteroids, sug- treated with long-term topical corticosteroids, usually gesting that a significant proportion of these syndromes with escalating dosage and frequency of application. In are attributable to chronic corticosteroid usage and the majority of patients, the initial symptom of pruritus “corticosteroid addiction.” The medical literature per- commonly evolved into a characteristic, severe burning taining to these syndromes usually has implicated sun sensation. In many cases, systemic corticosteroids had exposure, occult allergens, or psychosomatic reactions also been administered to relieve the severe erythema as the cause of ongoing skin eruptions.2–4 We consider and burning, but this only exacerbated the condition. In “corticosteroid addiction” of the skin to be the pertinent our opinion the continuing dermatitis resulted from etiologic factor in the majority of these patients. “steroid addiction.” Unfortunately, the time required for corticosteroid withdrawal mirrored the time over Syndromes which they had originally been applied, and was often Red Face Syndrome protracted. Examination of eyelid skin usually revealed atrophy Two hundred and one patients with chronic red face and telangiectasia. Patch testing, including four differ- syndrome were seen, 80% of whom began with eyelid ent corticosteroid allergens, demonstrated only irritant dermatitis.
    [Show full text]
  • Patch-Testing with Serial Dilutions of Tixocortol Pivalate and Potential Cross-Reactive Substances
    Acta Derm Venereol 2000; 80: 33±38 Patch-testing with Serial Dilutions of Tixocortol Pivalate and Potential Cross-reactive Substances MARLE NE ISAKSSON1, MAGNUS BRUZE1, AN GOOSSENS2 and JEAN-PIERRE LEPOITTEVIN3 1Department of Occupational and Environmental Dermatology, MalmoÈ University Hospital, MalmoÈ, Sweden, 2Department of Dermatology, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium and 3Laboratoire de Dermatochimie associe au CNRS, Universite Louis-Pasteur, Clinique Dermatologique, Strasbourg, France Of patch-tested patients with dermatitis, 4 ± 5% are allergic to corticosteroids should therefore be able to cross-react with corticosteroids. Four groups of corticosteroids are recognized both these substances. (A ± D), where substances from the same group may cross-react. In order to investigate the potential cross-reactivity pattern We investigated the potential cross-reactivity pattern and dose- and dose-response relationship, a study was undertaken, in response relationship for several corticosteroids from group A. which patients allergic to tixocortol pivalate were patch-tested We also included the corresponding aldehyde to hydrocortisone, with other substances from group A. as this degradation product has been proposed to be Recent patch-test results (6) have shown, that positive immunogenic. Eleven patients shown to be allergic to tixocortol patch-test results to the more recently developed methyl- pivalate were patch-tested with several corticosteroids from prednisolone aceponate (MPA) (belonging to group D) group A, as well as with the aldehyde, all in serial dilutions. All correlate signi®cantly (pv0.01) with reactions obtained 11 reacted to both tixocortol pivalate and hydrocortisone. The with group A corticosteroids. We therefore also included dose-response relationship for the corticosteroids tended to be this non-halogenated corticoid diester in the patch-test similar to sensitizers lacking anti-in¯ammatory potential.
    [Show full text]
  • Reazioni Avverse Ai Corticosteroidi
    S.O.S.S.O.S. AllergologiaAllergologia ee ImmunologiaImmunologia ClinicaClinica Ospedale San Giovanni di Dio Azienda Sanitaria di Firenze Responsabile : Dr. Maurizio Severino Stefania Capretti, Giuseppe Ermini, Maria L Iorno, Donatella Macchia , Sergio Testi Reazioni avverse ai corticosteroidi 12 aprile 2013 ADVERSE DRUG REACTIONS Not predictable, usually not dose dependent, sometimes reactions to very small amounts Type A Type B 80% of all side effects 15-20% of all side effects Idiosyncratic reactions Hypersensitivity reactions Immune mediated Non immune mediate (drug allergy) “pseudoallergy” Predictable, strictly dose dependent Pharmacological side effects (e.g. gastrointestinal bleeding IgE - mediated under treatment with NSAID, or bradycardia with β bloker treatment) Non IgE - mediated Johansson SGO et al. J Allergy Clin Immunol 2004 Hypersensitivity reactions Immediate reactions Nonimmediate reactions Are those occurring Are those occurring within 1 h more than 1 h after the last drug admistration after the last drug administration Basic structure of a corticosteroid molecule (hydrocortisone) • i corticosteroidi sono i farmaci più frequentemente usati per trattare le malattie allergiche • paradossalmente, sono stati riportati casi di reazioni di ipersensibilità, in alcuni casi anche reazioni con pericolo per la vita Rachid R JACI 2011 Pathophysiology corticosteroids Corticosteroids are low molecular weight compounds that act as haptens and need to bind to proteins to induce a hypersensitivity reaction. Bundgaard in 1980 suggested that corticosteroids were degraded to a Corticosteroid glyoxol corticosteroid glyoxol that then reacts with + arginine molecules of proteins to form the complete antigen. Arginyne molecules of proteins Complete antigen Bundgaard H. The possible implication of steroid-glyoxal degradation products in allergic reactions to corticosteroids.
    [Show full text]