Volume 4 Supplement 3
Anaphylaxis due to I.V. prednisolone application in two patients suffering from multiple sclerosis
- Tamar Kinaciyan1
© Kinaciyan; licensee BioMed Central Ltd. 2014
Published: 18 July 2014
Just a few weeks apart, two women in their forties were presented by neurologists at our outpatient clinic. Both suffered from multiple sclerosis (MS) and were always successfully treated with i.v. prednisolone when in acute relapse. Both patients developed at the last treatment with prednisolone generalized urticara, dyspnea and hypotension. They were then treated and stabilized with antihistamines and volume expanders.
Skin-Prick (SPT) and intradermal (i.d.) tests were performed with prednisolone as the probable causative agent and as alternatives with methylprednisolone, triamcinolone and dexamethasone. Additionally, drug provocation tests (DPT) with alternatives and / or SPT negative preparations were performed intravenously.
All prick tests resulted in both patients negative. In one patient, only i.d. test with prednisolone turned positive, all other steroids were negative and she tolerated i.v. application of negative tested steroids. In the other patient, the i.d. test with prednisolone and methylprednisolone were positive and she tolerated DPT with triamcinolone well.
Corticosteroid preparations are used to treat allergic reactions and anaphylaxis but in patients who are often treated with systemic steroids, as it was the case in both of our patients with MS, allergic sensitization to steroids can develop. Therefore, allergologic work-up is required for all suspected corticosteroid immediate type reactions. As methylprednisolone may cross-react with prednisolone in some cases, in acute emergencies, it is recommended to switch to triamcinolone or dexamethasone.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.