A day in the life of a patch tester – Steroid allergy – SURPRISE!
Steroid allergy: I saw a patient with ‘recalcitrant eczema’ that was doing fairly well, flares here and there. Being told there’s nothing on my back – should mean exactly that – but when I checked – there was a 2+ positive reaction.
I can not stress enough how nice it is to have either a photo or a map of patch placement to be able to go back and figure out what chemical is causing that reaction…
So we aligned a ‘decoder’ grid – and lo and behold were able to identify the placement of budesonide, a class B steroid (steroid allergy). Asked about the current treatment regimen and low and behold the patient is using a class B steroid daily – well, we won’t be doing that anymore…
There are three corticosteroids on the Food and Drug Administration approved (for adults) patch test – they are a recognized allergens…https://www.dermatitisacademy.com/corticosteroids/
So, what is the surprise in this?
Well, the patient was patch tested by another provider 82 days earlier – the steroid had not shown up as a positive during the patch procedure week.
Is this commonly reported? No. could it have been potentially missed? Yes.
Conclusion – always watch for late delayed reactions and “flare up” responses… especially in steroid allergy, as steroids have anti-inflammatory properties.
Wow! Is right. Can upu re-explain how many days the patient was probably using the class B steroid after the initial patch test, and how many days after the second patch test ( did i understand correctly; they were patch tested again to the exact same panel allergen series but 82 days later again?) and how many days after second testing fldid the class b steroid allergy response show up? So ; curious as to the delayed reaction: how delayed ?
The patient was using the class B steroid for more than a year. The reaction didn’t show up during the 7 day window of the patch test. The patient continued to use their steroid on inflamed skin at other parts of their body. 82 days later the original patch test site ‘lit up’ – recalled the response of using the steroids at a distant site.