Volume 19 Issue 2 June 2010Case Report
Type IV delayed-type hypersensitivity of the respiratory tract
due to budesonide use: report of two cases and a literature
review
Pages 185-188
*Constantinos Pitsiosa, Efthalia C Stefanakia, Arthur Helblingb
a
Allergy Outpatient Department, Social Insurance Institute, Athens, Greece
b
Division of Allergology, Department of Rheumatology, Clinical Immunology and Allergology, University Hospital, Bern, Switzerland
Received 16 April 2009 • Accepted 18 July 2009 • Online 13 October 2009
Abstract
Respiratory type-IV hypersensitivity reactions due to corticosteroids is a rare phenomenon. We describe two such cases. The first is a 37-
year-old atopic woman who developed labial angioedema and nasal itching after the use of budesonide nasal spray. A month later, after
the first puffs of a formoterol/budesonide spray prescribed for asthma, she noticed symptoms of tongue and oropharyngeal itching and
redness with subsequent dysphagia, labial and tongue angioedema, and facial oedema. The second is a 15-year-old non-atopic woman
who reported pruritic eruptions around the nostrils after using a budesonide nasal spray. A year later she presented with nasal pruritus
with intense congestion and labial and facial oedema after using the same spray. Both patients were evaluated with patch-tests using
the commercial T.R.U.E. test®, a budesonide solution, and corticosteroid creams. Test evaluation was performed at 48 and 96 hours. In
both patients, patch tests were positive to budesonide (++) on the second day. The first patient also had a positive (+) reaction to
tixocortol-21-pivalate. All the other patch tests were negative. Clinicians should be aware that hypersensitivity reactions may occur during
the use of nasal or inhaled corticosteroids.
Keywords
Corticosteroids, topical, inhaled, type-IV hypersensitivity reaction, budesonide, patch tests
* Corresponding author. Constantinos Pitsios Fax: +30 210 7211831 Email: pitsios@yahoo.com | |
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