Immediate Hypersensitivity Reactions Induced by Triamcinolone in a Patient with Atopic Dermatitis

Corticosteroids are potent anti-inflammatory and anti-allergic agents used in the treatment of various inflammatory diseases, including allergic disease. They are frequently considered the therapy-of-choice for many skin diseases. However, allergic reactions caused by corticosteroids have been reported. Among these, delayed reactions to topical steroids are more common, whereas immediate reactions to systemic steroids are rare. Herein, we report the case of a 32-year-old woman with triamcinolone-induced immediate hypersensitivity reaction, in which the patient had a positive prick test result with triamcinolone. She has had atopic dermatitis (AD) for three years. She had used systemic steroid, cyclosporine, and antihistamine with topical steroids for AD. In clinic, approximately 10 minutes after intralesional injection of triamcinolone, she complained of erythematous patches with slight elevation and itching on the face, trunk, and both hands. After intravenous injection of dexamethasone, her symptoms got worse. After treatment with epinephrine, all symptoms resolved within two hours. We performed an open test and skin prick test. She had a positive result only from the prick test with triamcinolone; all other steroids showed negative results from the open tests. Dermatologists should be aware of the possibility of anaphylaxis or other allergic hypersensitivity in response to corticosteroids.

Provocation Test of Non-Immunologic Contact Urticaria / 대한피부과학회지

This study was undertaken to investigate to compare the ratio of positive reactions to benzoic acid(BA), sorbic acid(SA) and cinnamic acid(CA) which are well known materials producing non-immunologic contact urticaria. Various concentrations(0.l% to 5%) and different vehicles(petrolatum, water, hydrophilic ointment base) were used in open and 20 minutes closed test using Finn chamber on Scanpor tape. One hundred total subjects were consisted of nonallergic patients and normal persons. The results were as follows ; 1. Total numbers of positive reactions were 69 in closed test(CT) and 60 in open test(OT), regardless of the materials and vehicles. 2. Total riumbers of positive reactions in BA, SA and CA were 68, 31, 35 in CT and 59, 20, 14 in OT respectably. 3. CT showed much more positive reactions than OT with all materials tested except 0.l% SA in water. 4. Hydrophilic ointment base showed a better reactivity than any other vehicles in CT. But in OT, petrolatum, water, hydrophilic ointment base showed better reactivity in BA, SA, CA respectably. 5. Almost all the reactions appeared within 45 minutes and disappeared within 3 hours. Erythema preceded edema and persisted 30 minutes to 1 hour after dissappearance of edema. 6 Itching, burning and tingling sensation were the only symptoms observed except. localized erythema and edema.