Immediate hypersensitivity reaction induced by hydrocortisone hemisuccinate – case report

Abstract

Introduction. Corticosteroids are a category of drugs, extensively used in the treatment of various pathologies due to a powerful anti-inflammatory effect. Despite being one of the classes of drugs used for the treatment of allergic reactions, corticosteroids may also induce both immediate and delayed hypersensitivity reactions, type I and type IV being most commonly reported in current medical practice. Case report. We present the case of a patient who was admitted to our clinic to investigate an episode of papular erythematous, pruritic skin eruption accompanied by tachycardia and drop of blood pressure, and malaise. Symptomatology started a few minutes after intravenous administration of dexamethasone and hydrocortisone hemisuccinate (HHC) for some prurigo lesions on the lower limbs.The symptomatology resolved after the administration of intravenous adrenaline and H1 antihistamine. We evaluated the patient for atopic status, the investigations performed (total IgE, skin test to common aeroallergens) ruling out the atopic status. We performed prick and intradermal skin testing on HHC and dexamethasone. The evaluation revealed hypersensitivity to HHC and ruled out the one to dexamethasone. Since systemic corticosteroids represent a class of multiple‑use drugs, and there is no therapeutic alternative, we conducted an oral challenge test on dexamethasone, which was negative. Conclusions. Immediate hypersensitivity reactions to HHC are rare. In addressing such a case, cross-reactivities should be considered, and studying the classification of corticosteroid groups is indispensable for making the right decision, giving the patient the chance to use a very important therapeutic class.