Contact Allergen of the Year: Corticosteroids

Marléne Isaksson; Magnus Bruze

Disclosures

Dermatitis. 2005;16(1):3-5. 

In This Article

Late Readings

The third issue is the importance of performing late readings, mainly because of intrinsic antiinflammatory properties that may influence the patch-test result. The allergic reaction may be suppressed at early readings, and negative patch-test reactions may be seen despite the patient's being allergic to the particular corticosteroid.[27] Therefore, an additional reading on day 6 or 7 has been recommended,[20,22,25,38] and the following description of one of our recent patients illustrates this very important point. A 50-year-old woman who worked on a restaurant staff had been suffering from what she strongly suspected was a work-related hand dermatitis for a year. She had used a cream containing Hc-17-B daily during the previous year. Patch tests with a standard series containing the three aforementioned corticosteroid markers and with a corticosteroid series were performed. She reacted only to budesonide and only on day 7 (not on day 3). Budesonide cross-reacts with Hc-17-B and seems to be a better marker for Hc-17-B allergy than is Hc-17-B itself, tested at 1.0% in ethanol. After she stopped using the cream containing Hc-17-B and after treatment with another corticosteroid that did not cross-react with budesonide or Hc-17-B, her condition cleared within a month, and she has not had any lesions since.

A Swedish study was the first to investigate the importance of consistent late readings in consecutive dermatitis patients being routinely patch-tested with corticosteroids. Thirty percent of the cases of contact allergy to corticosteroids would have been missed had not readings on day 7 (late readings) been performed. Since then, this phenomenon has been shown in other studies.[28,29]


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