![]() My fear is further reaction might be more severe. The third reaction again pain at the site and involving the whole extremity but started within one hour - moderate severe pain requiring pain killers, no redness, rash, fever warmth, or noticeable swelling. Second dose caused local pain at the site radiating into the whole extremity which got worse in 8-10 hours persisted for 10 days. Question: A 74 year-old old female with polymyalgia rheumatica on depo medrol 80 mg every 3 weeks (oral avoided due to abdominal issues). Steroid Allergy: Clinical Features and the Importance of Excipient Testing in a Diagnostic Algorithm. Li PH, Wagner A, Thomas I, Watts TJ, Rutkowski R, Rutkowski K. Skin testing for immediate hypersensitivity to corticosteroids: a case series and literature review. Skin testing may be of help but excipients are a concern.ġ. In summary, without a challenge there is no confirmation of allergy. Also, there is an increased occurrence of corticosteroid allergy in subjects with aspirin exacerbated respiratory disease (AERD). The predictive value of this testing is not validated. The concentrations in this question for skin testing with methylprednisolone is 20mg/ml and 2 mg/ml for percutaneous testing and 0.2 mg/ml and 2 mg/ml for intradermal testing. ![]() I have copied a question and answer from the archives of Ask the Expert. This study confirms the importance of testing for excipients, especially in patients with confirmed corticosteroid allergy.” Interestingly 5/9 were allergic to the excipient, while the remaining 4 did not complete the testing to exclude excipient allergy. Only 9/64 patients had confirmed corticosteroid allergy, most through drug challenge (confirming the importance of drug challenge in excluding and confirming a diagnosis). Drug challenges were performed after negative tests and “were tailored to the individual. Testing was performed using artificial tears as a source of CMC and a common laxative as a source of PEG. In addition, they also performed testing with excipients commonly found in corticosteroids including carboxymethylcelluose (CMC) and polyethylene glycol (PEG). Prick tests were performed with stock solutions and intradermal tests were performed with 1:10 dilution. “Over 100 cases of immediate reactions to corticosteroids have been published.(1) The largest series of patients evaluated thus far included 64 patients with immediate reactions.(2) The corticosteroids tested were dexamethasone, hydrocortisone, methylprednisolone, and triamcinolone. He has published on the topic of drug allergy. David Khan, program director for allergy/immunology at the University of Texas Southwestern Medical Center and a member of the practice parameter task force.
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