Hydrocortisone anaphylactic shock

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). 

A 24-year-old healthy volunteer was given 10 ml of 6% dextran 60 during a preliminary examination (24). After about 5 minutes the first clinical symptoms of anaphylactic shock were evident, with a reduction in systolic blood pressure to 90 mmHg and an increased heart rate to over 90/minute. These returned to normal after therapy in the head-down position with clemastine 2 ml (2mg), hydrocortisone 200 mg, and etherified starch 500 ml over about 8 minutes. During this period, responsiveness was unsatisfactory although he complained of warming of the skin, paresthesia, and nausea. 

Local injection can be effective, e.g. into the affected region in tendinitis, or sometimes intrathecally. Systemic administration is normally reserved for short-term use or emergencies, such as anaphylactic shock. Examples of this type include betamethasone, clobetasol, cortisone, hydrocortisone, prednisolone and triamcinolone. 

Hanashiro PK, Weil MH (1967) Anaphylactic shock in man report of two cases with detailed hemodynamic and metabolic studies. Arch Intern Med 119 129-140 Hayhurst M, Braude A, Benatar SR (1978) Anaphylactic-like reaction to hydrocortisone. S Afr Med J 18 259-260... 

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