Pulmonary function testing

Corticosteroids, which are potent anti-inflammatory and immunomodulator agents used in the treatment of various inflammatory diseases including allergic diseases, can in some cases produce immediate or delayed hypersensitivity reactions This review summarizes the epidemiological and clinical characteristics of such reactions, including related diagnostic issues It also presents a detailed analysis of the proposed immunological mechanisms including underlying cross-reactions

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1398-9995.2009.02038.x

Allergic hypersensitivity to topical and systemic corticosteroids: a review.

Background In systemic administration the prevalence of anaphylactic reactions attributable to corticosteroids is approximately 0.3%. Positive prick tests with different corticosteroids have been reported suggesting an immunoglobulin (Ig)E-mediated mechanism. Objective A 42-year-old man with multiple sclerosis developed flush, erythema, and itching a few minutes after the begin of an intravenous infusion of methylprednisolone-21-sodium succinate. Diagnostic and Results Prick tests were found to be positive with methylprednisolone-21-sodium succinate and prednisolone-21-sodium succinate, whereas prick tests with prednisolone without ester and betamethasone-21-dihydrogen phosphate showed negative results. Oral challenge with prednisolone without ester and intravenous challenge with betamethasone-21-dihydrogen phosphate were well tolerated. Specific IgE-antibodies against methylprednisolone-21-sodium succinate were found in the serum of the patient. Because of the positive prick test and specific IgE antibodies against methylprednisolone-21-sodium succinate, the diagnosis of IgE-mediated anaphylactic reaction could be proven. Succinate ester was suspected to be immunogenic, as other corticosteroids without this particular ester or with other substitutions at the C21 remained negative both in the prick and the challenge tests. Conclusions This patient showed an adverse reaction caused by methylprednisolone-21-sodium succinate. The uniqueness in this case was the presence of specific IgE antibodies against this esterified corticosteroid in the patient's serum proving that this reaction was based upon a true IgE-mediated mechanism.

IgE-mediated anaphylactic reaction induced by succinate ester of methylprednisolone

Intralesional corticosteroid (CS) injections have been used to treat a variety of dermatological and non-dermatological diseases with variable results. The purpose of the injection is to attain a high concentration of the drug at the diseased site, with minimal systemic absorption. Several CS preparations are available for intralesional injection, although triamcinolone derivatives have gained the widest usage in dermatology. The dose and the interval between injections depend on the type, size and severity of the lesion as well as the response to the previous injections. The most critical issue in the efficacy and also in the development of complications of the injections, is the method of injection. Several local and systemic side-effects have been reported following intralesional injections, but most of them are rare or acceptable. Thus intralesional CS injection is an integral part of the clinical practice of dermatology. Since their introduction in 1951, intralesional CS injections have become an integral part of clinical practice in dermatology. They are used alone or in combination with other therapeutic modalities in the treatment of many skin diseases. The purpose of the injection is to attain a high local concentration of the CS at the diseased site, without significant systemic absorption, thus avoiding the numerous side-effects associated with systemic administration. Intralesional CS injection may be a valuable therapeutic modality in situations where topical CS are not suitable for use, either because of low potency and inefficient epidermal barrier penetration or in clinical conditions associated with epidermal atrophy.

Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases.

OBJECTIVE:To review reported cases of suspected allergic reactions to various corticosteroids.DATA SOURCES:A MEDLINE search (January 1966–December 1997) was performed to obtain case reports and review articles on allergic-type reactions to corticosteroids. Further references were obtained from these publications.STUDY SELECTION:Reports involving allergic or allergic-type reactions to systemic administration of corticosteroids were chosen for this review. An allergic-type reaction was defined as any reaction after administration of the drug that involved the appearance of adverse symptoms that are characteristic of unwanted immune responses. These symptoms include rash, sneezing, dyspnea, edema, bronchospasm, or death. Articles were excluded from the evaluation if they described reactions to topical, intraarticular, or ophthalmic corticosteroid administration.DATA SYNTHESIS:Corticosteroids are medications that are often used to treat allergic reactions. However, it appears that patients can also have aller...

Allergic-Type Reactions to Corticosteroids

Eleven patients with intrinsic asthma and aspirin sensitivity were challenged with intravenous hydrocortisone sodium succinate (Solu-Cortef; the Upjohn Co., Kalamazoo, Mich.). Three patients showed definite evidence of bronchospasm, which was easily reversed by subcutaneous administration of epinephrine. Evidence is presented which suggests that this reaction was not caused by other constituents of the preparation but rather was caused by Solu-Cortef alone. No atopy was demonstrated in the group as a whole, and the reaction observed was probably nonallergic in nature. We suggest the replacement of intravenous hydrocortisone sodium succinate with dexamethasone in the treatment of such a population.

https://www.jacionline.org/article/0091-6749(81)90184-6/pdf

Bronchospasm caused by intravenous hydrocortisone sodium succinate (Solu-Cortef) in aspirin-sensitive asthmatics.

A sample of 204 male and 224 female healthy Jordanian children was selected to determine the normal ventilatory functions of this Arab population. Forced vital capacity (FVC), one-second forced expiratory volume (FEV1), and forced mid-expiratory flow rate (FMFR 25-75%) were determined with a dry bellows spirometer. Multiple linear regression formulae and correlation coefficients were computed for the group. Jordanian values for FVC and FEV1 were similar to those of Caucasians living in the Western hemisphere.

https://thorax.bmj.com/content/thoraxjnl/37/11/854.full.pdf

Pulmonary function in normal Jordanian children.

A 3 1/2-year-old British girl died in cardio-pulmonary arrest after ingesting an unknown amount of Lomotil® tablets. Chemical analysis by gas-liquid chromatography confirmed the presence of high le...

Basem M. Dajani

Papers

Bronchospasm caused by intravenous hydrocortisone sodium succinate (Solu-Cortef) in aspirin-sensitive asthmatics.

Pulmonary function in normal Jordanian children.

A case of fatal Lomotil overdosage.