Q:

8/1/2013
Setting up testing percutaneous and intradermal for reaction to steroid, what 3 medications do you recommend using and should we use dilutions like PCN testing?

A:

Thank you for your inquiry.

Before I deal directly with your question, I refer you to the recent position paper from the European Academy of Allergy, Asthma, and Immunology entitled “Skin Test Concentrations for Systemically Administered Drugs - an ENDA/EAACI Drug Allergy Interest Group Position Paper. Allergy 2013 (June); Volume 68, Issue 6, Pages 702-712.

This article is the best and most recent publication of which I am aware that discusses skin testing to drugs and also gives appropriate, nonirritating concentrations for skin tests to drugs where such has been studied and documented.

A direct statement from this article is: “Glucocorticoids rarely cause immediate hypersensitivity reactions, and a general recommendation for all glucocorticoids is currently not possible.” I agree with this statement, and therefore I cannot give you a direct answer to your question. We simply do not have enough information.

I can give you published concentrations which have not been fully documented as valid, but have been used in case reports for methylprednisolone and triamcinolone. For methylprednisolone, you would do an epicutaneous test with 2 mg/ml and 20 mg/ml, and intradermal at a concentration of 0.2 mg/ml and 2 mg/ml. For triamcinolone, it has been suggested that you use a concentration of 4 mg/ml and 40 mg/ml for percutaneous tests, and for intradermal tests, a concentration of 0.4 mg/ml and 4 mg/ml.

There may be other case reports in the literature using other corticosteroids, but I am not aware of these and they are not listed in the document mentioned above. Normally what one would do if a patient had reacted to a specific corticosteroid and you wished to see if there was a case report citing concentrations, one would do a literature search using the key words “skin testing,” and then the specific corticosteroid in question. Of course, it would not be possible for me to do a literature search at this time for each one of these. Therefore, what is normally done is, not a routine panel for steroid skin testing, but a search for the specific drug in question and then perhaps, should an alternate be needed, use the concentrations mentioned above for methylprednisolone and triamcinolone.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology