STEROID-INDUCED ANAPHYLAXIS

To report a severe adverse drug reaction (ADR) due to administration of injection hydrocortisone sodium succinate and to explore the possibility of an association between injection hydrocortisone and the severe ADR. After getting ethics approval from the institution, ADR form and patient’s clinical record from the Department of Cardiology, in a Private Medical College was received. In that, it was recorded as a 75-year-old male patient, a case of unstable angina with troponin T - positive, was posted for coronary angiogram developed a severe reaction to intravenous (IV) hydrocortisone 100 mg stat, given to prevent allergy to contrast dye used in the procedure. 5 minutes after drug administration, he developed sudden itching all over the body, hypotension blood pressure: 60 mmHg and swelling of lips. No other drugs had been given at that time. The patient was already on aspirin 150 mg, clopidogrel 75 mg, and atorvastatin 80 mg, and enoxaparin 40 mg. The procedure was abandoned, and the patient was given injection pheniramine maleate 45.5 mg IV, injection dopamine 10 mcg/kg/min IV. He symptomatically improved within 6 hrs. Causality analysis using the WHO scale categorizes it as probable, as anaphylaxis occurred immediately after administration of hydrocortisone, no other drugs were given at that time, and rechallenge was not done. Very few cases of various steroid-induced anaphylaxis have been reported worldwide. This one among the rare ADR report may be due to the steroid or the excipients in the preparation. Skin prick test or in vitro (radioallergosorbent test assay) test can be done immediately to confirm the causative allergen in this case and would also help in identifying specific agents that will be tolerated in the future treatment.

Study of Allergic Rhinitis in Childhood

Allergic rhinitis is common among children and quite often represents a stage of the atopic march. Although sensitization to food and airborne allergens may appear in infancy and early childhood, symptoms of the disease are usually present after age 3. The aim of this study was to determine the most frequent food and indoor and outdoor respiratory allergens involved in allergic rhinitis in children in the region of Piraeus. The study was performed in the outpatient clinic of otolaryngologic allergy of a general hospital. Fifty children (ranged 6–14 ) with symptoms of allergic rhinitis and positive radioallergosorbent test (RAST) for IgE antibodies or skin prick tests were included in the study. Thirty six (72%) of the subjects of the study had intermittent allergic rhinitis. The most common aeroallergens determined were grass pollens and Parietaria, whereas egg and milk were the food allergens identified. The detection of indoor and outdoor allergens in the region of Piraeus, based on skin prick tests and RAST tests, showed high incidence of grasses and food allergens, which is similar to other Mediterranean countries.