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Corticosteroid allergy is ‘under-recognised’

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Corticosteroid allergy is ‘under-recognised’

Prescription drugs, OTC topicals and cosmetics may trigger contact allergy, a new analysis of patch testing performed in 12 European countries shows. The study suggests corticosteroid allergy “might be under-recognised”.

Researchers analysed the patch testing of 59,728 patients between 2009 and 2012, including 15,532 people from 13 centres in the UK. Positive (allergic) reactions were common with 1% sodium metabisulfite (3.11 per cent positive), 30% lanolin alcohols (1.70 per cent) and 10% caine mix III (benzocaine, cinchocaine and tetracaine; 1.27%).

In addition, 0.42 and 1.5 per cent of patients tested positive to 0.1% and 0.01% budesonide respectively. The authors comment that corticosteroid allergy “may present as a poor response to a topical steroid treatment, rather than as typical contact dermatitis” and, as a result, might be under-recognised.

Traditional treatments can also cause contact dermatitis. For example, Compositae mix contains Arnica montana, Chamomilla recutita and other plants depending on the formulation. In this study, 1.09, 1.73 and 0.67 per cent tested positive for 2.5%, 5% and 6% Compositae mix respectively.

About one in 40 tested positive for 10% propolis (2.48 per cent), used in food supplements, ‘folk’ medicines (as an antibacterial, antifungal and antiviral) and included in, for example, some shampoos, conditioners, lipsticks, nail varnishes and toothpastes.

The authors suggest that “patch testing suspected culprit products … is often necessary as there is a limited number of test haptens commercially available”. (Haptens are small molecules that can evoke an immune reaction when combined with a protein or another larger carrier.) If the patch test is positive, testing individual ingredients could identify, and allow the person to avoid, the trigger.

Pharmacoepidemiology and Drug Safety DOI: 10.1002/pds.4064

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