Corticosteroids
(2022) Cutaneous Drug Hypersensitivity — ISBN: [9783030827427], p. 239-250, published
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- Abstract
- Although unexpected and paradoxical, allergic hypersensitivity to corticosteroids is a common finding, delayed-type reactions being much more frequently encountered than the immediate-type ones. However, knowledge of such reactions is critical since an appropriate diagnostic work-up will allow avoiding recurrences of dermatitis and, in the case of immediate reactions, possible fatal complications related to the readministration of the culprit corticosteroid molecule. The anti-inflammatory properties of corticosteroids may mask the clinical signs of allergy, thus rendering the skin test results difficult to interpret. Sensitized patients frequently test positively to several corticosteroids. Corticosteroids have been classified into three different groups, according to their structural and molecular characteristics. Molecules of the third group (the halogenated and C16-methylated molecules) are less sensitizing than those of Group 1 and Group 2 and should thus be preferentially prescribed. Moreover, two subgroups of corticosteroid-sensitized patients with probably different areas of immune recognition have been identified: Profile 1 patients, who react to molecules from one unique group, i.e., Group 1 for whom electrostatic fields (molecular charge) seem important; and Profile 2 patients who may react to the entire spectrum of CSs, i.e., Group 1 and Group 2 and/or Group 3 for whom steric fields (molecular structure) are determinant, and who probably present a global recognition of the CS skeleton. Determining the patient’s sensitization/tolerance profile is absolutely necessary to define the potential replacement agents that can still be tolerated.
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Citations
Baeck, M., & Goossens, A. (2022). Corticosteroids. In Bircher, A.J., Maibach, H.I., Brockow, K., Barbaud, A. (ed.), Cutaneous Drug Hypersensitivity (p. p. 239-250). Springer, Cham. https://doi.org/10.1007/978-3-030-82743-4_27