All About Steroid Allergy

Corticosteroids (commonly referred to as steroids) are medications used to treat a wide variety of inflammatory conditions including allergies and autoimmune disorders.

Unfortunately, it is possible to have an allergic reaction to steroids that are often prescribed to treat allergies.

Steroids may be used topically, inhaled, or given by injection, Depending on the specific medication, they are available by prescription and over the counter.

This article explains the types of steroids used and why and how steroids may cause an allergic reaction. It also addresses what to do if you think you're having a reaction.

Uses of Steroids

Corticosteroids are commonly used to treat, among other things:

• Allergic reactions to foods, drugs, or insect bites.
• Allergic rhinitis (hay fever)
• Anaphylaxis (a potentially life-threatening allergic reaction)
• Asthma
• Atopic dermatitis (eczema)
• Contact dermatitis
• Lupus
• Multiple sclerosis
• Rheumatoid arthritis
• Urticaria (hives)

Topical and Inhaled Steroid Allergy

Topical corticosteroids include medications that you rub on your skin and inhaled steroids are intranasal medications that you spray into your nostrils. Reactions to these drugs tend to be mild and are estimated to occur in 0.3% to 4.7% of cases.

If a topical steroid allergy is suspected, it is often difficult to discern whether the rash is related to the drug or is simply a worsening of the underlying condition. Similarly, a reaction to an inhaled corticosteroid could as easily be blamed on the underlying allergy.

Systemic Steroid Allergy

Systemic corticosteroids include both oral and injected formulations. They are considered systemic because they are distributed through the entire body as opposed to localized treatment.

While systemic reactions are rare, they can be life-threatening. Those that develop rapidly are considerably more dangerous. Systemic reactions can develop in one of two ways:

Immediate reactions most often occur within an hour of a drug being taken. Symptoms may include hives, facial swelling, respiratory distress, rapid heart rate, fever, confusion, and a blistering skin rash.

Non-immediate reactions are usually mild and can occur up to 48 hours following the use of an oral or injected drug. Symptoms may include hives or a disseminated (widespread) rash.

Diagnosing Steroid Allergies

Diagnosing a topical or inhaled steroid allergy involves allergy patch testing. Commercially available assays, such as the TRUE test, can assess a person's sensitivity to a wide range of corticosteroid drugs. Patch testing can be tricky, however, since the anti-inflammatory effects of the steroids can sometimes dampen the reaction and lead to a false negative result.

Diagnosing immediate reactions to systemic steroids involves the use of a skin test and/or radioallergosorbent (RAST) test. Since the tests are prone to false negatives, a negative result should be followed by a drug challenge (in which a person is given a low dose of the drug to see if they react).

For non-immediate allergic reactions, a skin or patch test may be used to diagnose the condition. However, the reading should be delayed for one to two days, and possibly up to seven days, to compensate for the delayed nature of the reactions.

Treatment

If it is determined that you are allergic to a particular steroid, your healthcare provider may recommend trying a different steroid or desensitization.

When your body’s immune system becomes sensitized to a substance in the medication, it perceives it as a foreign invader and releases chemicals to defend against it. Drug desensitization involves taking the drug in increasing amounts until you can tolerate the needed dose with minimal side effects. This will most likely be done in a hospital so immediate medical care is available if problems develop.

Desensitization only helps if you are taking the drug every day. Once you stop it you will need to go through desensitization a second time if you need the drug again.

Summary

Steroids are medications used topically, inhaled, or given by injection to treat a wide variety of inflammatory conditions. Sometimes people have an allergic reaction to steroids that can be diagnosed with a skin or patch test or a RAST test. Treatment may include trying a different steroid medication or going through a process of desensitization.