Glucocorticoids rarely cause anaphylaxis. Common methods for the determination of allergens include in vivo skin prick test (SPT) and intradermal skin test (IDST) and the in vitro basophil activation test (BAT). However, to our knowledge, the best strategy for diagnosing glucocorticoid-induced anaphylaxis has not been elucidated. A 10-year-old boy was admitted to our hospital because of 2 weeks of fever and arthralgia. He had not been treated with glucocorticoids before, including methylprednisolone (mPSL). He was suspected to have bacterial myositis and was treated with ceftriaxone. However, his symptoms persisted for > 2 weeks. Autoinflammatory arthritis was suspected, and he was treated with mPSL sodium succinate (MPS) pulse therapy (30 mg/kg). After 15 min of mPSL injection, he had wheezing and generalized wheal formation with decreased oxygen saturation. As anaphylaxis was suspected, mPSL was discontinued, and olopatadine and oxygen were administered. The symptoms improved considerably without the use of epinephrine and disappeared in 30 min. One month after discharge, SPT, IDST, and BAT were performed without discontinuing his prescribed oral prednisolone. SPTs for MPS, hydrocortisone sodium succinate (HCS), prednisolone sodium succinate (PSS), dexamethasone sodium phosphate (DSP), and betamethasone sodium phosphate (BSP) were negative. IDSTs for MPS, HCS, and PSS were positive, whereas those for DSP and BSP were negative. By contrast, BATs for MPS, HCS, and PSS were negative. Although glucocorticoid-induced hypersensitivity caused by nonmedicinal ingredients such as lactose, carboxymethylcellulose, polyethylene glycol, and hexylene glycol has been reported; the glucocorticoids tested in this patient did not contain any of these nonmedicinal ingredients. As the glucocorticoids that were positive on IDST share a succinate ester, this might have caused MPS-induced anaphylaxis. We report the case of MPS-induced anaphylaxis diagnosed by IDST but not BAT. In case reports of glucocorticoid-induced anaphylaxis in the literature, most patients were diagnosed with SPT or IDST. These results suggest that BAT should be considered when IDST and SPT are negative. Further studies are necessary to clarify the best strategy for diagnosing glucocorticoid-induced anaphylaxis.

中文翻译：

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皮内皮试诊断甲泼尼龙致过敏反应一例

糖皮质激素很少引起过敏反应。测定过敏原的常用方法包括体内皮肤点刺试验（SPT）和皮内皮肤试验（IDST）和体外嗜碱性粒细胞活化试验（BAT）。然而，据我们所知，诊断糖皮质激素引起的过敏反应的最佳策略尚未阐明。一名 10 岁男孩因发热和关节痛 2 周入院。他之前没有接受过糖皮质激素治疗，包括甲基强的松龙 (mPSL)。他被怀疑患有细菌性肌炎，并接受了头孢曲松治疗。然而，他的症状持续了 > 2 周。怀疑自身炎症性关节炎，他接受了 mPSL 琥珀酸钠 (MPS) 冲击疗法 (30 mg/kg)。mPSL 注射 15 分钟后，他有喘息和全身风团形成，氧饱和度降低。由于怀疑出现过敏反应，因此停用 mPSL，并给予奥洛他定和氧气。症状在不使用肾上腺素的情况下显着改善并在 30 分钟内消失。出院后 1 个月，SPT、IDST 和 BAT 没有停止他的处方口服泼尼松龙。MPS、氢化可的松琥珀酸钠 (HCS)、泼尼松龙琥珀酸钠 (PSS)、地塞米松磷酸钠 (DSP) 和倍他米松磷酸钠 (BSP) 的 SPT 均为阴性。MPS、HCS 和 PSS 的 IDST 为阳性，而 DSP 和 BSP 的 IDST 为阴性。相比之下，MPS、HCS 和 PSS 的 BAT 为阴性。虽然由非药用成分如乳糖、羧甲基纤维素、聚乙二醇、己二醇已有报道；在该患者中测试的糖皮质激素不含任何这些非药用成分。由于对 IDST 呈阳性的糖皮质激素共享一种琥珀酸酯，这可能会导致 MPS 诱发的过敏反应。我们报告了由 IDST 而非 BAT 诊断的 MPS 诱发的过敏反应的病例。在文献中关于糖皮质激素引起的过敏反应的病例报告中，大多数患者被诊断为 SPT 或 IDST。这些结果表明，当 IDST 和 SPT 为阴性时，应考虑 BAT。需要进一步的研究来阐明诊断糖皮质激素引起的过敏反应的最佳策略。由于对 IDST 呈阳性的糖皮质激素共享一种琥珀酸酯，这可能会导致 MPS 诱发的过敏反应。我们报告了由 IDST 而非 BAT 诊断的 MPS 诱发的过敏反应的病例。在文献中关于糖皮质激素引起的过敏反应的病例报告中，大多数患者被诊断为 SPT 或 IDST。这些结果表明，当 IDST 和 SPT 为阴性时，应考虑 BAT。需要进一步的研究来阐明诊断糖皮质激素引起的过敏反应的最佳策略。由于对 IDST 呈阳性的糖皮质激素共享一种琥珀酸酯，这可能会导致 MPS 诱发的过敏反应。我们报告了由 IDST 而非 BAT 诊断的 MPS 诱发的过敏反应的病例。在文献中关于糖皮质激素引起的过敏反应的病例报告中，大多数患者被诊断为 SPT 或 IDST。这些结果表明，当 IDST 和 SPT 为阴性时，应考虑 BAT。需要进一步的研究来阐明诊断糖皮质激素引起的过敏反应的最佳策略。这些结果表明，当 IDST 和 SPT 为阴性时，应考虑 BAT。需要进一步的研究来阐明诊断糖皮质激素引起的过敏反应的最佳策略。这些结果表明，当 IDST 和 SPT 为阴性时，应考虑 BAT。需要进一步的研究来阐明诊断糖皮质激素引起的过敏反应的最佳策略。