Immediate allergic reaction to methylprednisolone with tolerance of other corticosteroids

Abstract

Introduction. In spite of the wide usage of corticosteroids for the treatment of a plethora of diseases, sometimes they can induce immediate hypersensitivity reactions, which are however uncommon. Case Outline. We report a case of immediate allergic reaction induced by intravenous methylprednisolone given before operation for surgical repair of an arm contracture as a sequel of burns, which the child had tolerated a month before. Six weeks later the patient repeated the anaphylactic reaction during skin testing to methylprednisolone. In addition, basophile activation test with methylprednisolone (BAT) was positive. Conclusion. This case report describes a patient who experienced intraoperative anaphylaxis and anaphylactic reaction induced by skin testing. This is the first report on induction of both anaphylactic reactions by methylprednisolone in the same child. Clinical findings, positive BAT and positive skin tests with methylprednisolone imply that the child developed type-I hypersensitivity. The lack of cross-reactivity with other corticosteroids emphasizes that the reactions were caused by the steroid molecule.Uvod. Uprkos sirokoj primeni kortikosteroida u lecenju od razlicitih bolesti, oni ponekad mogu izazvati ranu alergijsku reakciju. Prikaz bolesnika. Kod dvanaestogodisnjeg decaka doslo je do rane alergijske reakcije izazvane intravenskom primenom metilprednizolona neposredno pre hirurske intervencije, tacnije, korekcije kontrakture sake koja se javila kao komplikacija opekotine. Mesec dana pre pojave alergijske reakcije dete je primalo metilprednizolon i dobro ga podnosilo. Sest nedelja posle operacije ponovo se javila anafilakticka reakcija tokom koznog testiranja metilprednizolonom. Primenjen je i test aktivacije bazofila (BAT) ovim lekom, ciji je nalaz bio pozitivan. Zakljucak. Ovo je prvi prikaz dve vrste anafilakticke reakcije izazvane metilprednizolonom kod iste osobe. Klinicka slika, pozitivni nalaz BAT i pozitivne kozne probe na metilprednizolon pokazuju da se kod deteta razvio prvi tip hipersenzitivne reakcije. Nedostatak unakrsne reaktivnosti s ostalim kortikosteroidima ukazuje na to da je alergijska reakcija izazvana steroidnim molekulom. PR Projekat Ministarstva nauke Republike Srbije, br. 172049 i br. 172024