Allergic contact dermatitis to inhalation corticosteroids

Inhaled and intranasal corticosteroids (CS) are used to treat various inflammatory or allergic diseases of the upper and lower respiratory tract. Despite their wide use, only a few reports about their sensitization potential have been published. We determined the frequency, clinical signs and molecules responsible for skin allergic reactions following inhalation of corticosteroids amongst patients with identified and investigated "contact allergy" to corticosteroids. We reviewed clinical data, patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K.U. Leuven Dermatology department during an 18-year period. 12 subjects (out of 315 with contact allergy to CS) presented with allergic manifestations due to nasal or orally inhaled corticosteroids, 11 of which were due to budesonide and one to tixocortol pivalate. Amongst patients with "contact allergy" to corticosteroids, very few were found with allergic manifestations due to inhaled corticosteroids. Budesonide was the major allergen found. Other inhalation corticosteroids such as beclomethasone, mometasone and fluticasone derivatives may, in most cases, still be used, since they do not cross react with budesonide.