Skin tests positive, prednisolone

A 64-year-old woman with allergic alveolitis caused by parakeet feathers improved with intravenous methylprednisolone, and was given oral deflazacort 60 mg/day, to be reduced progressively. After 30 days she developed generalized itchy blotches and lip edema. At that time she was mistakenly taking deflazacort in a dose of 120 mg/day. She was given an antihistamine, without any improvement. Deflazacort was then replaced by prednisolone and her symptoms disappeared immediately. Skin tests (a prick test and an epicutaneous test) were positive with deflazacort. Oral provocation with deflazacort 30 mg was positive, with the immediate appearance of the same symptoms as in the initial episode. 

An asthmatic patient using inhaled budesonide and salbutamol developed an acute asthma attack. Despite emergency treatment the patient deteriorated, requiring endotracheal intubation and assisted ventilation, and there was no improvement until the glucocorticoid was withdrawn, after which there was steady improvement. Skin prick tests with prednisolone, sodium hemisuccinate, and 6-methylprednisolone-sodium hemisuccinate were positive. Thirty minutes after intradermal 6-methylprednisolone-sodium hemisuccinate 4 mg, the patient developed a dry cough, dyspnea, and wheezing and a 17% fall in FEVi. 

A 62-year-old woman, who had applied DoloPosterine N ointment topically to the perianal skin and rectal mucosa for several days, developed erythematous vesicular lesions in the perianal area and an erythematous edematous rash of the face, axillae, elbow flexures, and inner thighs (7). This abated on withdrawal of the drug and the administration of oral prednisolone for 10 days. Patch testing was positive with cinchocaine. 

An 82-year-old Korean man developed a fever and cough accompanied by a generalized erythematous rash. He had taken mexiletine for 5 months for a dilated cardiomyopathy and ventricular dysrhythmias. There was a peripheral blood eosinophilia and raised liver aminotransferase activities. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions showed eosinophihc infiltration. After withdrawal of mexiletine and administration of oral prednisolone he improved and the skin and lung lesions disappeared. A patch test with mexiletine was positive. 

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