Contact allergy to corticosteroids in asthma/rhinitis patients

Patients with asthma and/or rhinitis, when using inhalers or nasal sprays containing corticosteroids, may experience mucosal symptoms, such as congestion of the nose, itching, nose bleeding and worsening of rhinitis, but also eczema of the face sometimes spreading to flexures, and sometimes the corticosteroid simply does not help. Few patients with such symptoms have been found to be allergic to their inhaled corticosteroids (1), and no report on whether contact allergy to corticosteroids could explain treatment failures is available. This issue was investigated in 2 ways: (i) by testing asthma/rhinitis patients for corticosteroid allergy, (ii) by looking at the prevalence of tixocortol pivalate allergy among dermatitis patients with and without asthma/rhinitis, respectively.     

Contact allergy due to halogenated corticosteroids

Statistical evaluation of epicutaneous tests performed in 5348 patients during the years 1976 to 1980 revealed positive reactions towards topical steroids in nine cases. Three patients showed an allergy due to Dermoxin (Dermovate). Further tests with the single components of the steroidal cream disclosed a specific hypersensitivity towards clobetasol-17-propionate in two cases, towards the preservative 4-chlor-m-kresol in the third case. Cross-reactions to other fluorinated corticosteroids were not obtained. Experimental sensitisation with clobetasol-17-propionate in guinea pigs remained negative although different methods have been employed.     

Contact allergy to corticosteroids and Malassezia furfur in seborrhoeic dermatitis patients

Background Seborrhoeic dermatitis (SD) is a chronic skin disease, requiring long‐term treatment, which might promote sensitization. Malassezia furfur (Mf) plays an important role in seborrhoeic dermatitis. Objectives The aim of this study was to determine the frequency of contact sensitivity in SD patients. Patients and methods A total of 100 patients and 20 healthy controls (HC) were investigated: 50 suffering from SD with no previous local corticosteroid treatment (SDN), 50 SD patients treated with local corticosteroids (SDC). Mycological examination for Mf was performed. All patients were patch tested with the baseline standard, corticosteroid series, with 12 commercial corticosteroid preparations frequently used in Croatia; and also with Mf. Results Malassezia furfur was found in 44 (88%) SDN, 37 (74%) SDC, and in 4 (20%) HC; patch test reaction to Mf was positive in one SDN and in three SDC. Positive patch tests to standard allergens were observed in 17 (34%) SDN, 33 (66%) SDC and 2 (10%) HC. Patch tests to the corticosteroid series revealed positive reactions in 4 SDC and to commercial corticosteroids in seven patients, i.e. 2 SD and 5 SDC. Conclusions Patch tests to the baseline series and to both individual corticosteroid and commercial corticosteroid preparations should be performed in SD patients with persistent dermatitis, as contact‐allergic reactions may complicate their dermatitis. Sensitization to Mf was found to be infrequent.     

Contact allergy to corticosteroids: the results of a two-centre study

Summary We report a comparative study of the patch-test results obtained with a corticosteroid series, added to the standard series, in two centres, one in Belgium and the other in the Netherlands. The frequencies of positive reactions to the corticosteroids differed considerably between the two centres, and we suggest several reasons for this.     

Contact allergy to gold in dental patients

Summary Gold sodium thiosulphate (GSTS) In patch test series commonly yields positive reactions. In this study of dental patients, the clinical relevance of these positive reactions, the suitability of gold compounds as patch test materials, and value of the lymphocyte proliferation test in gold contact allergy, were evaluated. The frequency of positive patch test reactions to GSTS was 12·4% in the dental series. Fifty-two patients, only two of whom were male, were studied. Thirteen (25%) had had symptoms from jewellery or dental restorations. However, in most cases gold allergy was subclinical. A 10% aqueous solution of gold sodium thiomalate (GSTM) was almost as good as 0·5% GSTS in petrolatum as a marker of gold contact allergy, but 0·001% potassium dicyanoaurate (PDCA) yielded a high percentage of false-negative results. Seventy-three per cent of the subjects with positive patch tests to GSTS responded to gold compounds in vitro in the lymphocyte proliferation test, whereas 13 controls without gold contact sensitivity were negative. Consistent results in skin and lymphocyte proliferation tests provide support for the concept that gold salt-induced'allergic-like' reactions are truly allergic in nature.     

Contact allergy in 330 dermatological patients

A total of 330 patients with eczematous lesions were tested with 27 topical substances. Among the 88 patients with leg ulcers, 85 (2%) were allergic to one or more substances present in one out of two cases of allergy to wool alcohol. Among the 242 patients suffering from eczematous dermatitis, the percentage of allergic reactions reached 54.6%. A great number of allergic reactions of cetyl alcohol (11.2%), chloramphenicol (10%) and sodium lauryl sulfate (6.4%) was observed. These allergens are not included in the European standard series adopted by the ICDRG. The findings are discussed and compared with data taken from the literature.