Acute Urticaria Induced by Systemic Corticosteroids in Patient with Pre-existing Aspirin Exacerbated Respiratory Disease

INTRODUCTION Despite the allergic, inflammatory, and immunologic modulating properties of corticosteroids, acute and delayed hypersensitivity reactions have been reported.1-9 There is increasing data regarding hypersensitivity reactions to systemic corticosteroids from these reports. The prevalence of hypersensitivity reactions with topical corticosteroids is 2.9 6%10-12 and less than 1% with inhaled and systemic corticosteroids.1,2,13 Delayed hypersensitivity reactions after topical corticosteroid use have been reported for decades and they were recognized as the allergen of the year in 2005 by the American Contact Dermatitis Society.14 Acute IgE-mediated hypersensitivity reactions occurring within one hour are characterized by urticaria and anaphylaxis; while delayed T-cell mediated reactions are characterized by urticaria and maculopapular exanthems.14,15 Reactions may occur to the corticosteroid or to its allergens, making it difficult to identify the true culprit.15 We identified a patient without pre-existing urticaria who exhibited hypersensitivity reactions to oral steroids (prednisone and methylprednisolone), inhaled corticosteroids/long-acting beta agonists (fluticasone/salmeterol and budesonide/formoterol), and aspirin which caused acute urticaria, angioedema, and bronchospasm. Clinicians, particularly emergency room staff, must be aware of the potential for hypersensitivity to corticosteroids and consider it in the differential diagnosis of a patient who has received corticosteroids with subsequent sequelae of a hypersensitivity reaction.