(541) Unmasking a Rarity: Steroid-Induced Anaphylaxis

Introduction: Steroids are widely used well tolerated anti-inflammatory medications. In rare cases, patients may exhibit hypersensitivity reactions, including anaphylaxis. This presents a challenge, as steroids are a crucial treatment for many conditions. We present a patient who developed anaphylaxis after receiving intravenous methylprednisolone for lymphoma. The patient was successfully desensitized to oral prednisone, allowing for continued steroid therapy

Description: 54-year-old female with B Cell Lymphoma of neck presented for excisional lymph node dissection. On post-op day two, she received IV methylprednisolone for lymphoma. Shortly after, she developed significant facial swelling, redness and diffuse body rash associated with shortness of breath, wheezing and dysphagia. She received epinephrine, diphenhydramine and famotidine resulting in significant symptom improvement. She underwent fiberoptic exam revealing mild subglottic edema without significant laryngeal edema. She denied prior steroid use. She subsequently received a prednisone based steroid desensitization protocol consisting of 1 followed by 5 mg and ultimately100 mg without any reaction

Discussion: This case highlights the rare and potentially life-threatening complication of steroid hypersensitivity in a patient requiring steroid treatment for lymphoma. While steroid allergy is uncommon, occurring in approximately 0.1-0.3% of patients receiving systemic steroids, it can present a major therapeutic dilemma when steroids are indicated. It is thought that the steroid molecule itself is usually not directly antigenic, but rather the succinate (as seen in this case) or phosphate esters used to make water soluble formulations of steroids that act as haptens, evoking an immune response. Reactions tend to be severe and rapid with parenteral versus oral administration. When steroid therapy is essential, desensitization is a viable management strategy. In this case, oral prednisone was used as it lacks the succinate ester present in the IV methylprednisolone formulation that may have been the antigenic trigger. This case underscores the importance of recognizing steroid hypersensitivity and illustrates that desensitization can be a successful strategy for managing this condition when steroid therapy is necessary