Corticosteroids delayed hypersensitivity reactions

Rarely have complications from CS exposure included haemoptysis and haematemesis (Anderson et al., 1996). A case of multisystem hypersensitivity reaction characterized by delayed development of cutaneous rash, pneumonitis, hypoxaemia, hepatitis and hypereosinophilia, with rapid response to corticosteroids, was described in a man heavily exposed to CS solution spray. The authors ascribed this to a systemic allergic reaction patch testing confirmed sensitization to CS (Hill et al., 2000). The possible abuse and complications from illegal drugs should be considered where clinical suspicions exists (Hayman and Berkely, 1971). Physicians should be aware of the possible contribution from formulation constituents some may exacerbate effects known to be produced by RCAs (e.g. eye injury and skin irritation) and others may introduce additional toxicological factors (such as the development of carbon monoxide intoxication from the absorption and metabolism of dichloromethane as a formulation solvent). 

Precautions Doses may be modified or therapy delayed for toxicity (myelosuppression). Adjust dose for hepatic impairment. Avoid use of docetaxel in patients with elevated bilirubin. Corticosteroids and antihistamines (i.e., cimetidine and diphenhydramine) are recommended to lessen risk for anaphylactoid reactions with paditaxel. Pretreatment with steroids is required for docetaxel to minimize risk for fluid retention and hypersensitivity. 

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