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.