Aspects of Allergic Reactions to ACTH

In this section, we shall no longer consider accidents due to the old form of ACTH, but deal only with accidents due to the new, synthetic forms. We shall give three clinical examples of allergic accidents certainly due to synthetic corticotrophin. 

Case 1. A 56-year-old woman, suffering from asthma with permanent dyspnea and undergoing long-term steroid therapy received a monthly injection of 1 mg depot tetracosapeptide. On 8 November 1968, she had her ninth injection without incident. On 8 December 1968,15 min after the tenth injection, cutaneous pruritus, generalized eruption, and dyspnea developed. The patient did not inform us of the incident and on 8 January 1969, she had the eleventh injection, resulting in eruption and immediate acute dyspnea. In 48 h, she improved and was cured within 12 days. On 13 March 1969, skin tests were positive (Fig. 1) with 1 100 and 1 1,000 dilutions of tetracosapeptide. She was hospitalized again on 10 December 1969 for an acute attack of asthma. For 14 days she received DW 75 pentacosapep-tide, first at very small doses (25 lU) then for the last six injections 200 lU daily, without any incident. 

Case 2. A 53-year-old woman undergoing long-term steroid therapy for asthma with permanent dyspnea, received, from 15 September 1967 untilJanuary 1969,16 monthly 1 mg tetracosapeptide injections. Then she had an injection every two weeks. The 21st injection on 10 March 1969, was followed by lumbar pains and vomiting but no eruption. On 24 March 1969, 0.25 mg depot tetracosapeptide was injected the same phenomena followed the next day with Quincke s edema and generalized urticaria. Tests were positive to 1 100 dilution of tetracosapeptide. 

Case 2. A 58-year-old woman undergoing long-term steroid therapy for severe asthma with permanent dyspnea had never received ACTH before hospitalization because of an asthma attack on 24 June 1970. On 3 July 1970, at the very beginning of the perfusion, she had heat sensations then general pruritus, finally eruption on the superior members with very marked oppression. Perfusion was stopped. On 4 July 1970, she was still taking steroids skin test reactions were negative to DW 75, positive to 1 10 dilution of tetracosapeptide, and negative at 1 100. She received 25, then 100 lU pentacosapeptide without any incident. 

We see in these three cases some of the usual characteristics of these accidents. The most frequent incidents appear on the skin  

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