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 oedemia. 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 sholud be aware that hypersensitivity reactions may occur during the use of nasal or inhaled corticosteroids.
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Pitsios, C., Stefanaki, E. & Helbling, A. Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review. Prim Care Respir J 19, 185–188 (2010). https://doi.org/10.4104/pcrj.2009.00061
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DOI: https://doi.org/10.4104/pcrj.2009.00061
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