Anesth Analg 2006;102:1904-1905
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215116.78109.9E
LETTER TO THE EDITOR
Immediate Allergic Reaction to Betamethasone During Anesthesia
Keiko Hama, MD,
Katsutoshi Nakahata, MD,
Hiroshi Iranami, MD, and
Yoshio Hatano, MD
Department of Anesthesiology; Wakayama Medical University; Wakayama, Japan; hama1008kei{at}yahoo.co.jp
To the Editor:
Glucocorticoids rarely cause anaphylactic reactions (approximately 0.3%) (1,2). We present the occurrence of and immediate allergic reaction to betamethasone sodium phosphate during anesthesia.
A 58-yr-old female undergoing tympanoplasty under general anesthesia developed abrupt hypotension (systolic blood pressure below 60 mm Hg), bronchospasm, and erythema 2 min after IV administration of 2 mg of betamethasone sodium phosphate. Her arterial blood pressure was maintained with repeated doses of ephedrine and epinephrine, as well as administration of crystalloid solutions. Bronchoconstriction was treated with inhaled bronchodilators (procatetel HCl). The surgery was completed, and she fully recovered.
Two months after the procedure, the patient underwent lymphocyte transformation test and intradermal prick test against betamethasone and the three additives in the solution. Lymphocyte transformation test was uniformly negative, whereas betamethasone, but not the three additives, elicited a reaction to the intradermal prick.
These results suggested that betamethasone produced an immediate allergic reaction. Betamethasone lacks the succinate moiety that is coupled to methylprednisolone and hydrocortisone to render them water soluble. This moiety is thought to enhance the immunogenicity of these glucocorticoids (1–4). Nevertheless, betamethasone is able to trigger anaphylaxis. Anesthesiologists should consider acute allergic reaction when confronted with cardiovascular and respiratory compromise after administration of a corticosteroid.
References
- Burgdorff T, Venemalm L, Vogt T, et al. IgE-mediated anaphylactic reaction induced by succinate ester of methylprednisolone. Ann Allergy Asthma Immunol 2002;89:425–8.[Web of Science][Medline]
- Kamm GL, Hagmeyer KO. Allergic type reactions to corticosteroids. Ann Pharmacother 1999;33:451–60.[Abstract]
- Ventura MT, Calogiuri GF, Matino MG, et al. Alternative glucocorticoids for use in cases of adverse reaction to systemic glucocorticoids: a study on 10 patients. Br J Dermatol 2003;148:139–41.[Medline]
- Nakamura H, Matsuse H, Obase Y, et al. Clinical evaluation of anaphylactic reactions to intravenous corticosteroids in adult asthmatics. Respiration 2002;69:309–13.[Medline]
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