Glucocorticoids contact allergy

Tixocortol pivalate is a marker for glucocorticoid contact allergy, as a positive patch test suggests established contact allergy to hydrocortisone, prednisolone, and their derivatives (95). A literature search via Medline from 1966 to May 2000 revealed only one patient hypersensitive to tixocortol pivalate and budesonide in a pilot study in 34 patients (10 with asthma, 13 with rhinitis, 11 with both) (96). From case reports, the prevalence of glucocorticoid-induced contact allergy has been estimated at 2.9-5%. 

Glucocorticoid contact allergy is well known (SEDA-21, 158) and has to be particularly suspected in chronic conditions affecting the perianal area (17), after long-term topical medication, and in cases of failure to ameliorate dermatitis with corticosteroids. Patch tests should then be performed both with the recommended markers, budeso-nide (0.1% petrolatum) and tixocortol pivalate (1% petrolatum), and with the patient s own formulations. 

Contact allergy to glucocorticoids is not rare in patients with atopic dermatitis. In patients with known contact allergy to budesonide, allergic skin reactions can also occur when inhaled forms of the drug are used, as shown by a randomized, double-bhnd, placebo-controlled study in 15 non-asthmatic patients with budesonide hypersensitivity on patch testing (101). In four of seven patients who used inhaled budesonide, there was reactivation of the 6-week-old patch test sites and they had new distant skin lesions. No flare-up reactions were observed in the other 11 patients (three had used inhaled budesonide and eight placebo for 1 week). None of the patients developed respiratory symptoms spirometry and peak expiratory flow rates remained normal. 

The authors noted that although contact allergic reactions to benzoyl alcohol are rarely reported, they can be responsible for contact allergy to topical glucocorticoid formulations. 

General anesthetics, see Anesthetics Germanium, 16.545 Glucocorticoids bone, 16.447, 22.182, 25.195 contact allergy, 15.139, 21.158 effective dose and therapeutic ratio, 23.175 and eyes, 29.481 and growth, 14.335 inhaled, children, risks in, 27.174 inhaled, effects on mouth and throat, 29.168... 

Contact hypersensitivity to pyridoxine is rare. Only three cases of allergy to pyridoxine have been reported in hair lotion (35), a glucocorticoid cream (36), and a skin cream (Iruxol) (37). There have also been a few reports of photosensitivity due to pyridoxine hydrochloride (30,31,33). 

---