Hypersensitivity to methylprednisolone sodium succinate in children with milk allergy

Rare but potentially fatal hypersensitivity reactions to intravenous corticosteroids have been described in the literature in recent years.1,2 Most reactions involve succinylated corticosteroids.3,4 The pathogenesis is considered to be immune-IgE mediated, in which the corticosteroid molecule serves as a hapten.1,3,4 The succinate esters seem to have a sensitizing potential.4 Adverse drug reactions may be caused by the active molecule itself or excipients (including food ingredients) added to the drug during preparation.5 In a 2009 report from Schneider Children's Medical Center of Israel, we described an anaphylactic reaction (urticaria and wheezing) in 3 children with asthma, 2 of whom also had IgE-mediated cow milk allergy, after treatment with intravenous methylprednisolone sodium succinate.6 After this experience, we designed a study to prospectively identify additional children in 2008 to 2011. Risk factors for corticosteroid hypersensitivity are asthma, nonsteroidal anti-inflammatory drug hypersensitivity, and multiple high-dose administrations. [...]it is not surprising that corticosteroid hypersensitivity has been reported more frequently in patients who were atopic, as in the present report, and renal transplantation recipients.1,3 However, prevalence data on hypersensitivity reactions to corticosteroids in the pediatric age group are still sparse.1 Rachid et al2 studied 15 patients with corticosteroid allergy, of whom 13 were between 3 and 15 years old; however, their sample, like ours, was derived from a children's hospital.