Hypersensitivity to methylprednisolone sodium succinate in children with milk allergy

Abstract

Rare but potentially fatal hypersensitivity reactions to intravenous corticosteroids have been described in the literature in recent years. Most reactions involve succinylated corticosteroids. The pathogenesis is considered to be immune-IgE mediated, in which the corticosteroid molecule serves as a hapten. The succinate esters seem to have a sensitizing potential. Adverse drug reactions may be caused by the active molecule itself or excipients (including food ingredients) added to the drug during preparation. In a 2009 report from Schneider Children’s Medical Center of Israel, we described an anaphylactic reaction (urticaria and wheezing) in 3 children with asthma, 2 of whom also had IgE-mediated cow milk allergy, after treatment with intravenous methylprednisolone sodium succinate. After this experience, we designed a study to prospectively identify additional children in 2008 to 2011. Inclusion criteria were children up to age 18 years old who exhibited signs and symptoms of systemic allergic reaction (urticaria or rash and at least 1 additional organ system involvement) immediately after intravenously or intramuscularly injected corticosteroid preparation. Afterward, the patients were referred from the emergency department and wards to our allergy clinic. Their clinical and laboratory data were retrieved from the computerized records of Schneider Children’s Medical Center of Israel, and an allergy evaluation was performed within 1 to 5 months of the