Some individuals have steroid allergy upon using corticosteroids. These medications are utilized to manage various inflammatory conditions including autoimmune and allergic conditions.
The medications are available in different formulations including oral, topical and injectable. Corticosteroids are commonly used to manage allergic conditions such as contact dermatitis, asthma, allergic rhinitis, atopic dermatitis, hives, angioedema, reactions to foods, insect bites and drugs as well as anaphylaxis.
It seems unusual for allergic reactions to corticosteroids to occur since these are utilized to treat allergic reactions. Even though severe reactions to corticosteroids are rare, they occur. Most cases of reactions are less severe and often triggered by the topical formulations. The reactions to injected or oral formulations are rare. The possible cause of the allergic reactions to corticosteroids might be due to the IgE antibodies or an outcome of a delayed-type hypersensitivity reaction due to T-cells.
Reactions to topical corticosteroids
The topical corticosteroids are commonly used for managing allergic skin reactions including contact dermatitis, atopic dermatitis as well as localized reaction due to insect bites and stings.
Remember that the reactions to topical corticosteroids might be hard to recognize. The diagnosis of reactions to the topical variants typically involves the use of a patch test. There are commercially available tests that can be used to test for allergy to common corticosteroids. Nevertheless, the patch test might also provide negative results since the anti-inflammatory effects of the medication might suppress a reaction.
Reactions to systemic corticosteroids
The systemic corticosteroids are usually taken orally and via injection. Even though allergic reactions are rare, it can be dangerous and life-threatening. The allergic reactions can develop as either immediate or non-immediate reactions.
The immediate reactions typically occur within 30-60 minutes after the medication is taken and the symptoms include the following:
- Hives and angioedema
- Asthma symptoms
- Anaphylaxis
This is likely triggered by IgE antibodies against the corticosteroid itself or to a preservative or other additive present in the medication. The diagnosis of an allergy to systemic corticosteroids involves skin testing and/or RAST testing although a negative result might follow by a drug challenge since it is not known how reliable the test is.
The non-immediate allergic reactions to systemic corticosteroids are typically mild and non-life threatening and likely to occur 24-48 hours after administration of the medication. The symptoms include urticarial or other forms of skin rashes. The skin testing and/or patch testing might be performed to diagnose the non-immediate reactions but the reading of these tests must be delayed for 1-2 days to consider the delayed nature of the reactions.