Worsening of asthma with systemic corticosteroids - A case report and review of literature
Worsening of asthma with systemic corticosteroids - A case report and review of literature
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DOI：
10.1111/j.1525-1497.2005.00290.x
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发表时间：
2006-02-01
影响因子：
5.7
通讯作者：
Jackson, R
中科院分区：
文献类型：
--
作者：
Sheth, A;Reddymasu, S;Jackson, R
尽管糖皮质激素广泛用于治疗哮喘和过敏，但糖皮质激素可能引起过敏反应，甚至过敏反应。全身使用糖皮质激素的不良反应发生率为0.3%。最常报告的引起过敏样反应的皮质类固醇是氢化可的松、泼尼松和甲泼尼龙。大多数作者认为，对全身性皮质类固醇的过敏反应可能是免疫球蛋白E介导的。我们报告一位患有气喘、阿司匹林过敏及鼻息肉的病人，在气喘急性发作时，静脉注射甲泼尼龙琥珀酸钠后发生支气管痉挛。我们讨论了尽管接受了充分治疗但哮喘恶化的鉴别诊断，并建议我们的患者出现皮质类固醇诱导的支气管痉挛。当哮喘患者全身皮质类固醇治疗无效或恶化时，应考虑皮质类固醇引起的支气管痉挛，尤其是当有阿司匹林过敏史时。教学要点：了解尽管治疗充分但哮喘恶化的鉴别诊断。当哮喘患者全身皮质类固醇治疗无效或恶化时，应考虑皮质类固醇引起的支气管痉挛。皮质类固醇引起的支气管痉挛在有阿司匹林过敏史的哮喘患者中更常见。
Despite widespread use for treatment of asthma and allergies, glucocorticoids may cause allergic reactions, even anaphylaxis. The incidence of adverse reactions to systemic glucocorticoids is 0.3%. The most commonly reported corticosteroids causing anaphylaxis like reactions are hydrocortisone, prednisone, and methylprednisolone. Most authors agree that allergic reactions to systemic corticosteroids are possibly immunoglobulin E mediated. We report a patient with asthma, aspirin allergy, and nasal polyps who developed bronchospasm following the administration of intravenous methylprednisolone sodium succinate during an acute asthmatic attack. We discuss the differential diagnosis of worsening asthma despite adequate treatment, and suggest corticosteroid-induced bronchospasm in our patient. Corticosteroid-induced bronchospasm should be considered when asthmatics fail to improve, or frankly deteriorate with systemic corticosteroid therapy, particularly when a history of aspirin allergy is present.Teaching Point:Know the differential diagnosis for worsening of asthma despite adequate treatment.Consider corticosteroid-induced bronchospasm when asthmatics fail to improve, or frankly deteriorate with systemic corticosteroid therapy.Corticosteroid-induced bronchospasm is more commonly seen in asthmatics with a history of aspirin allergy.