Drugs can induce different types of immunological reactions. Corticosteroids, which are used in the treatment of allergies (to animal hair, dust mites or even grass pollen such as timothy) are not immune to the phenomenon even if allergy in the strict sense of the term is very rare..
” In the event of an allergic reaction, it is better to talk abouthypersensitivity than allergyimmediately specifies Professor Jean-François Nicolas, specialized in clinical immunology and allergology. In fact, hypersensitivity to drugs is common but exceptionally severe and is allergic in only 10% of cases. »
Prednisolone, solupred: is it possible to be allergic to cortisone?
Cortisone is part of the class of so-called anti-inflammatory drugs as well as NSAIDs (non-steroidal anti-inflammatory drugs), paracetamol and aspirin. “Rather paradoxically, corticosteroids, powerful anti-inflammatories and immunomodulators used in the treatment of allergic manifestations in the broad sense, are in certain cases the cause of real immediate or delayed allergic hypersensitivity reactions. “, confides Professor Jean-François Nicolas.
Although the majority of accidents are non-allergic hypersensitivity reactions, it is important to clearly distinguish between hypersensitivity and a real allergy. ” Hypersensitivity accidents not Allergies very rarely cause problems and are benign in the vast majority of cases.assures the specialist. While allergic incidents are potentially severe. »
What are the side effects of cortisone?
Be careful not to confuse a hypersensitivity reaction to corticosteroids with the side effects of the drug. Like any chemical molecule, cortisone can indeed cause undesirable effects including:
- an increase in blood pressure;
- nervousness, agitation, sleep disturbances;
- weight gain, swelling and redness of the face.
If in doubt, do not hesitate to speak to a healthcare professional.
Rash, hives, cough, nausea: what are the signs of a cortisone allergy?
Immediate hypersensitivity to corticosteroids occurs very rapidly within a few minutes to less than an hour after taking the medication. and can manifest itself through symptoms such as:
Whether it is an allergy to hymenoptera (wasp) venom, food or medication, the symptoms are the same. Pr Jean-François Nicolas, specialized in immunology and allergology
L'drug-induced anaphylaxis includes four severity grades:
- grade 1: exclusive skin involvement;
- grade 2: involvement of at least two organs: skin and lung or digestive tract;
- grade 3: cardiovascular signs, hypotension;
- grade 4: cardio-respiratory arrest.
Can cortisone hypersensitivity cause itching?
Hypersensitivity to cortisone can definitely result in pruritus (itching). In general, when there are only isolated cutaneous signs, it is an immediate non-allergic hypersensitivitysays Professor Nicolas. We start to think of an allergic reaction from grade 2 of anaphylaxis. At least two organs must be affected to suspect an allergy. However, when faced with a patient who has had a reaction to the use of a corticosteroid, the diagnostic approach must be rigorous. It is important to define which replacement molecule can, if necessary, be administered to the patient subsequently. »
What to do in case of cortisone allergy? How to diagnose it?
In the event of an immediate reaction to a corticosteroid, you should consult your GP who will refer you if necessary to a specialized consultation in drug allergies. ” The assessment of drug allergy remains mostly hospital-basedconfirms the specialist. First, we see the patient and do a skin test with the corticosteroid in question. We put a drop on the skin and prick the inside of the drop. If the test is positive, we call him back to do new skin tests with a battery of corticosteroids. The goal is to identify an intravenous corticosteroid, an oral one, a cutaneous one and an inhaled one that the patient can receive without having a reaction. »
If immediate allergic hypersensitivity is diagnosed, the risk of anaphylactic shock being significant, the patient will leave the consultation with a card specifying his allergy to corticosteroidsauthorized medicines and their international non-proprietary name (INN).
” When the allergy assessment is negative (non-allergic hypersensitivity urticaria), resuming the medication is possible.continues Professor Nicolas. This reintroduction can be done with premedication with antihistamines and/or antileukotrienes. »
What causes hypersensitivity to corticosteroids?
Corticosteroids are part of the drug class known as anti-inflammatory drugs. By blocking the production of prostaglandinscorticosteroids will disrupt cell metabolism and this will cause an increase in the production of leukotrienes which have a pro-inflammatory activityexplains the specialist. In some patients who have a problem regulating the metabolism of leukotriene prostaglandins, by modifying this balance, anti-inflammatories in the broad sense – and corticosteroids in particular – will generate inflammatory symptoms. Paradoxically, anti-inflammatories are the drugs that most cause inflammatory reactions! »
How to treat a cortisone allergy? Is allergy desensitization or immunotherapy possible?
As with classic allergies, it is possible to carry out desensitization to a drug. If this were to be justified, one could very well carry out desensitization to cortisone.confirms Professor Nicolas. But there are so many different chemical formulations of corticosteroids that our goal is to identify an injectable corticosteroid, an oral one, a topical one, and an inhaled one that the patient can receive without having a reaction. So far, we have never had a case where we could not find these four molecules available.
Desensitization – known as allergen immunotherapy – is undertaken when there is no no drug alternativeI am thinking in particular of chemotherapies and anti-tuberculosis drugs. For other allergies – notably to beta-lactams – we always manage to find replacement solutions. »