Systemic allergic reaction due to intranasal budesonide.

Topical corticosteroids are frequently recognised as a cause of allergic contact dermatitis but in only few cases the administration of intranasal corticosteroids has been reported as the cause of systemic allergic reaction.1--6 A 34-year-old non-atopic woman started treatment with nasal budesonide for a common cold. On the second day of treatment the patient developed, 8 h after the administration of 256 mcg (two puff per nostril each time), lips, nose, and eyelid angioedema and pruritic urticarial papules in face, chest and arms. The symptoms remitted gradually over 3--4 days after treatment with hydroxyzine. Previously the patient had tolerated nasal budesonide without adverse effects. Prick and intradermal test were performed with a battery of corticosteroids (hydrocortisone, methylprednisolone, budesonide, triamcinolone, deflazacort and dexamethasone) (Table 1) with the excipients carboxymethylcellulose, Tween 80, and benzylalcohol. Prick tests were considered positive when a wheal of more than 3 mm in diameter was present 15 min later. When prick test responses were negative 0.02--0.05 ml of the reagent solution was injected intradermally. Readings were made 20 min after injection. Results were considered positive when wheal and erythema greater than 5 mm were present. Positive control for prick and intradermal tests were done with histamine, at 10 mg/ml and 1 mg/ml respectively. Sterile 0.9% saline was used as a negative control. Ten non-atopic and ten atopic subjects were also tested as a control.