Anaphylactic reaction succinate

A number of other agents may be required for the treatment of anaphylactic reactions. Corticosteroids (hydrocortisone sodium succinate intravenously) are recommended to reduce the risk of late-phase reactions. Aminophylline may be used as adjunctive therapy for bronchospasm. Histamine (Hi) receptor blockers (such as diphenhydramine) may be administered to reduce some of the symptoms associated with anaphylaxis however, these agents are not effective as primary therapy. 

Burgdorff T, Venemalm L, Vogt T, et al. IgE-mediated anaphylactic reaction induced by succinate ester of methylprednisolone. Arm Allergy Asthma Immunol. 2002 89 425-8. 

Anaphylactic reactions of immediate type have been reported after intravenous injection of hydrocortisone sodium succinate (77, 99, 12 ). Skin tests were either negative or only positive to hydrocortisone or methylprednisolone proper. Cases of contact dermatitis and angioneurotic oedema are still being published (84 =). 

Hydrocortisone is a relatively short-acting agent. For replacement therapy in adrenal insufficiency it is administered orally and in combination with fludrocortisone. Hydrocortisone sodium succinate is a water-soluble derivative which can be used parenter-ally in emergencies such as acute bronchospasm and hypersensitivity reactions like anaphylactic shock. 

Anaphylactic shock has been described after intranasal hydrocortisone acetate, intramuscular methylprednisolone (SEDA-21, 419) (251), intravenous methylprednisolone (SEDA-22, 448) (252), intramuscular dexamethasone (SEDA-22, 448) (253), and intra-articular methylprednisolone (SEDA-22, 449) (254). A life-threatening anaphylac-tic-like reaction to intravenous hydrocortisone has been described in patients with asthma (255). Acute laryngeal obstruction has been described for the first time after the intravenous administration of hydrocortisone (SEDA-22, 449) (256). There is some reason to believe that sodium succinate esters are more likely to cause hypersensitivity reactions (SEDA-17, 449), but unconjugated glucocorticoids can definitely produce allergy in some cases (SEDA-16, 452). 

---