Immediate Hypersensitivity Reactions Induced by Triamcinolone in a Patient with Atopic Dermatitis

Allergy against Steroids in Ocular Inflammation

Allergy to steroids is an uncommon and harmful condition that leads to a decrease in treatment options and increase in morbidity due to the suboptimal disease control. It can manifest as an immediate response or a delay manifestation. Worsening of underlying condition and not treatment response can indicate corticosteroids hypersensitivity as well. Despite its low prevalence, all clinicians should be aware of this condition and know the treatment options. This narrative review attempts to update information about corticosteroid allergy and we present a case of a patient with the diagnosis of Vogt Koyanagi Harada Syndrome with a history of steroids allergy, as an example, to integrate this information to the ocular inflammation field.

The Protein Level and Molecular Weight Analysis in Different Children's Toothpaste, which Probably Induced Hypersensitivity

CONTEXT

A new case of an allergic reaction due to the use of toothpaste was found in California, United States, causing the death of an 11-year-old girl. Ingredients contained in toothpaste suspected as a cause of allergies are milk protein compounds.

AIMS

The aim is to compare the protein level and molecular weight in children's toothpaste.

SETTINGS AND DESIGN

Stratified random sampling.

SUBJECTS AND METHODS

Samples used were children's toothpaste products in society, namely, Pepsodent®, Cussons®, Enzyme®, Kodomo®, Formula®, Colgate®, the toothpaste contain recaldent of GC Tooth Moose® and pure cow's milk. Those samples were divided into eight groups, randomly selected according to the purpose (stratified random sampling), and then coded to maintain product confidentiality. Meanwhile, samples used as comparison groups were recaldent paste and pure cow's milk.

RESULTS

Each sample was analyzed for protein content using a biuret test and protein molecular weight using the sodium dodecyl sulfate-polyacrylamide gel electrophoresis test. The protein content in toothpaste is compared with the similarity of the molecular protein weight in toothpaste that contains recaldent. Protein was found in samples 2, 3, 5, 6, 7, and 8 through a biuret test, with a concentration of 1.82; 1.53; 2.76; 1.92; 1.85; and 3.2 μg/mL. However, the protein bands were only found in sample 5 with a molecular weight of 20.7 kDa, sample 6 with a molecular weight of 19.1 kDa, sample 7 with a molecular weight of 17.7 kDa, and sample 8 with 2 bands, namely, 28.7 and 39.7 kDa.

CONCLUSIONS

We found the presence of protein in children's toothpaste. The protein molecular weight of recaldent paste is 17.7 kDa. Toothpaste containing protein with its molecular weight similar to recaldent's are found in samples 5 and 6.

Anaphylactic shock with methylprednisolone, Kounis syndrome and hypersensitivity to corticosteroids: a clinical paradox

Corticosteroids are widely used for the treatment of allergic reactions but paradoxically themselves may induce acute, delayed, local or systemic allergic reactions and even anaphylaxis with Kounis syndrome. They can suppress the release of arachidonic acid from mast cell membranes, via phospholipase A2 and eicosanoid biosynthesis inhibition. Corticosteroids can promote cell apoptosis and mediate in annexin or lipocortin synthesis, substances that modulate inflammatory cell activation, adhesion molecule expression, transmigratory and phagocytic functions. Antigen-antibody reaction, hapten formation, and medication contaminants are some of the incriminated causes. Patients with atopic diathesis are particularly vulnerable. Complete and thorough previous history of drug reactions or allergies is necessary before administration of any particular medication including corticosteroids.