Steroidunverträglichkeit

Steroid intolerance (Steroidunverträglichkeit in German) describes adverse reactions to corticosteroids, including true hypersensitivity to the drug and non-immunologic intolerance due to side effects. Corticosteroids include prednisone, methylprednisolone, dexamethasone, and topical steroids.

True immediate allergic reactions to corticosteroids are uncommon; most reactions are to excipients such as preservatives in injectable preparations or to contact dermatitis from topical steroids. Some patients experience pharmacologic intolerance, including mood changes, sleep disturbance, elevated blood glucose, fluid retention, or weight gain, particularly with systemic therapy. In addition, abrupt withdrawal after long-term use can cause symptoms.

Diagnosis is based on history and clinical evaluation. Allergic corticosteroid reactions can be evaluated by allergy specialists; skin tests and graded challenges may be used in selected cases, though tests have limited sensitivity. Distinguishing between allergy and side effects is essential, as management differs.

Management focuses on avoiding the offending formulation when possible. If a corticosteroid is essential, an alternative with a different chemical structure may be tried, ideally under medical supervision. Excipients should be avoided if implicated. For topical steroids, non-steroidal anti-inflammatory options or nonirritating formulations, and gradual reintroduction or desensitization is rarely needed. Overall prognosis is good when alternatives are available and underlying conditions are managed.