Anaphylaxie IgE-médiée au polysorbate 80 après injection épidurale de prednisolone

Abstract

IntroductionImmediate hypersensitivity to corticosteroids is rare. It may be caused by either the corticosteroid itself or one of the excipients. We report a case of polysorbate 80-related anaphylaxis after epidural injection of Hydrocortancyl® (prednisolone). Patients and methodsA 62-year-old lung-transplant patient consulted for assessment of grade III anaphylaxis after epidural infiltration of lidocaine, Visipaque® (iodixanol) and Hydrocortancyl® (prednisolone). Long-term treatment included Cortancyl® (prednisone). The skin tests (ST) for Visipaque® (iodixanol) and lidocaine were negative, as was the subcutaneous challenge test with lidocaine. The ST for corticosteroids were: positive for Hydrocortancyl® (prednisolone), Diprostene® (betamethasone) and Pulmicort® Nebulizing Solution (budesonide) and negative for Solupred® (prednisolone), Celestène® (betamethasone), Solumédrol® (methylprednisolone) and Hydrocortisone® (hydrocortisone). ST were negative for carboxymethylcellulose and benzyl alcohol (present in Hydrocortancyl® and Diprostene®) and positive for polysorbate 80 (present in Hydrocortancyl®, Diprostene® and Pulmicort® nebulizing solution). The Solupred® (prednisolone) oral challenge was negative. The diagnosis was IgE-mediated allergy to polysorbate 80. The patient's long-term treatment included omeprazole, which contains polysorbate 80. DiscussionPolysorbate 80 has been implicated in cases of drug hypersensitivity and anaphylaxis, including 2 cases following intramuscular injection of dexamethasone. In our clinical case, the good safety of omeprazole is explained by the absence of gastrointestinal absorption of polysorbate 80. ConclusionInvestigation of the involvement of polysorbate 80 in an immediate hypersensitivity reaction to parenterally administered corticosteroids is essential in order to avoid unnecessary withdrawal of a corticosteroid or the risk of subsequent exposure.