Zusammenfassung
Wir berichten über eine 66-jährige Patientin, die am Tag
nach paravertebraler Infiltrationstherapie mit Carbostesin®
0,5 % (Bupivacainhydrochlorid) und Predni 25 mg
Lichtenstein N® (Prednisolonacetat) wegen degenerativer HWS-Symptomatik,
ein generalisiertes, urtikarielles Exanthem entwickelte. Mit Epikutantestungen
konnte eine Spättypreaktion gegenüber Prednisolon und Budesonid
nachgewiesen werden. Unter Berücksichtigung der Klassifikation von
Glukokortikoiden hinsichtlich der Kreuzreaktivitäten nach Dooms-Goosens,
ist Prednisolon der Steroid-Kontaktallergie-Gruppe A und Budesonid der Gruppe B
zuzuordnen. Folglich führten wir eine lokale, orale und subkutane
Ausweichprovokationstestung mit Betamethasonvalerat, Fluocortolon und
Betamethason durch. Die verwandten Klasse C- und D1-Glukokortikoide wurden
allesamt ohne lokale oder systemische Reaktionen toleriert.
Abstract
We report on a sixty-six year old female patient, who developed a
generalized urticarial exanthema 24 hours after paravertebral injection of
bupivacainehydrochloride and prednisoloneacetate due to discomfort of the
cervical spine. By means of skin tests a delayed-type reaction to prednisolone
and budesonide was evaluated. According to the classification of
glucocorticoids regarding their cross-reactivity, prednisolone belongs to the
contact allergy-group A of steroids and budesonide to the group B. Accordingly,
we performed a local, an oral and a subcutaneous challenge with
bethametasone-valerate, fluocortolone and betamethasone. By provocation tests,
the compounds of the contact allergy-group C and D1 were tolerated without
local or systemic complications.
Literatur
-
1
Alexiou C. et al .
Clinical significance of allergic
reactions in glucocorticoid therapy.
Laryngorhinootologie.
1999;
78
573-578
-
2
Ashworth J. et al .
Effect of topical corticosteroid
therapy on Langerhans cell antigen presenting function in human skin.
Br J Dermatol.
1988;
118
457-470
-
3
Bircher A J. et al .
Delayed generalized allergic reactions
to corticosteroids.
Dermatology.
2000;
200
349-351
-
4
Cadinha S. et al .
Delayed hypersensitivity reactions to
corticosteroids.
Allergol Immunopathol (Madr).
2005;
33
329-332
-
5
Coloe J, Zirwas M J.
Allergens in corticosteroid vehicles.
Dermatitis.
2008;
19
38-42
-
6
Coopman S. et al .
Identification of cross-reaction
patterns in allergic contact dermatitis from topical corticosteroids.
Br J Dermatol.
1989;
121
27-34
-
7
Davis M D. et al .
Results of patch testing to a
corticosteroid series: a retrospective review of 1188 patients during 6 years
at Mayo Clinic.
J Am Acad Dermatol.
2007;
56
921-927
-
8
Dooms-Goossens A. et al .
Corticosteroid contact allergy: an
EECDRG multicentre study.
Contact Dermatitis.
1996;
35
40-44
-
9
Feldmann-Böddeker I.
Anaphylaktischer Schock nach Injektion von
Solu-Decortin H.
Akt Dermatol.
2007;
33
365-367
-
10
Gall H M, Paul E.
Ein Fall von Kortikosteroidallergie.
Der Hautarzt.
2001;
52
891-894
-
11
Goossens A. et al .
Reactions to corticosteroids: some new
aspects regarding cross-sensitivity.
Cutis.
2000;
65
43-45
-
12
Goossens A. et al .
Fluticasone propionate: a rare contact
sensitizer.
Eur J Dermatol.
2001;
11
29-34
-
13
Ijsselmuiden O E. et al .
Cutaneous adverse reactions after
intra-articular injection of triamcinolone acetonide.
Acta Derm Venereol.
1995;
75
57-58
-
14
Isaksson M. et al .
Patch testing with budesonide in
serial dilutions: the significance of dose, occlusion time and reading
time.
Contact Dermatitis.
1999;
40
24-31
-
15
Isaksson M. et al .
Patch testing with corticosteroid
mixes in Europe. A multicenter study of the EECDRG.
Contact Dermatitis.
2000;
42
27-35
-
16
Isaksson M. et al .
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
-
17
Kamm G L, Hagmeyer K O.
Allergic-type reactions to corticosteroids.
Ann Pharmacother.
1999;
33
451-460
-
18
Lehmann P. et al .
Corticosteroid contact dermatitis:
results of a multicenter study from the German Contact Allergy Group.
Dermatosen/Occup Environ.
1997;
45
116-120
-
19
Lepoittevin J P. et al .
Studies in patients with
corticosteroid contact allergy. Understanding cross-reactivity among different
steroids.
Arch Dermatol.
1995;
131
31-37
-
20
Mimesh S, Pratt M.
Allergic contact dermatitis from corticosteroids:
reproducibility of patch testing and correlation with intradermal testing.
Dermatitis.
2006;
17
137-142
-
21
Oppliger R, Hauser C.
Anaphylaxie nach Injektion von
Kortikosteroidpräparaten-Carboxymethylzellulose, ein verstecktes
Allergen.
JDDG.
2004;
2
928-930
-
22
Plaza T. et al .
Spättypallergien auf
Glukokortikoide.
Allergo J.
2008;
17
394-400
-
23 Ring J. Angewandte Allergologie. München; MMV Medizin Verlag 1995: 192-203
-
24
Rytter M. et al .
Allergic reactions of the immediate
and delayed type following prednisolon medication.
Dermatol Monatsschr.
1989;
175
44-48
-
25
Whitmore S E.
Delayed systemic allergic reactions to
corticosteroids.
Contact Dermatitis.
1995;
32
193-198
Dr. med. Hanan Adib-Tezer
Klinik für Dermatologie und Allergologie,
HSK,
Wilhelm-Fresenius-Klinik
Akademisches Lehrkrankenhaus
der Universität Mainz
Aukammallee 39
65191 Wiesbaden
Email: hanan.adib-tezer@hsk-wiesbaden.de
