Patch testing with serial dilutions of budesonide, its R and S diastereomers, and potentially cross-reacting substances

BACKGROUND: Budesonide, a marker for corticosteroid allergy, is a 1:1 mixture of 2 diastereomers, the R and S, present in all commercial formulations. Budesonide is said to cross-react with group B substances through the R and S diastereomer and some group D substances only through the S diastereomer. OBJECTIVE: To investigate the cross-reactivity pattern between the R and S diastereomers and 4 potentially cross-reacting substances, 2 from group B and 2 from group D. METHODS: By patch testing 10 patients hypersensitive to budesonide with a serial dilution of budesonide, the R and S diastereomer, triamcinolone acetonide, amcinonide, prednicarbate, and hydrocortisone-17-butyrate. RESULTS: Nine of 10 patients reacted to budesonide and the S diastereomer. Seven of 9 to the R diastereomer. Each of the 9 patients with S diastereomer allergy reacted to the group B and/or group D substances. Five patients reacted to triamcinolone acetonide, not to 1.0% but only to 0.0010% and 0.00010%. CONCLUSION: The R and S diastereomers can induce positive patch test reactions in budesonide-hypersensitive individuals. The potential of budesonide to cross-react with substances from group B and D might be explained by the presence of the 2 diastereomers. When patch testing with triamcinolone acetonide, much lower concentrations than recommended should be used.

Bruze, MagnusLund University,Lunds universitet,Yrkes- och miljödermatologi,Forskargrupper vid Lunds universitet,Occupational and Environmental Dermatology,Lund University Research Groups(Swepub:lu)derm-mbr (författare)
Lepoittevin, Jean-Pierre (författare)
Goossens, An (författare)
Yrkes- och miljödermatologiForskargrupper vid Lunds universitet (creator_code:org_t)

Ingår i:American Journal of Contact Dermatitis: Ovid Technologies (Wolters Kluwer Health)12:3, s. 170-1761046-199X

Av författaren/redakt...: Isaksson, M; Bruze, Magnus; Lepoittevin, Jea ...; Goossens, An

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