Abstract
This is a report of a 62-year-old farmer with a history of asthmatic attack following therapy for bronchial asthma with Hydrocortone Phosphate Injection. It contains hydrocortisone disodium phosphate and diluents.
He has had episodes of dyspnea since 1974, and has been treated with oral bronchodilaters and intermittent corticosteroids (dexamethasone). In 1976, he was treated with triamcinolone acetonide and hydrocortisone sodium hemisuccinate (Solu-Cortef or Saxison). Skin test to 20 antigens were negative. In 1976, he was admitted to Haramachi Red Cross Hospital for treatment of acute bronchial asthma. On August 1st, he was orthopnoeic and slightly cyanosed, so he was given 200mg of Hydrocortone Phosphate Injection intravenously. About 5 minutes after administration, a severe asthamtic attack occurred. To confirm the suspected relationship between the drugs and asthmatic attack, provocation challenge tests with Hydrocortone Phosphate Injection and other corticosteroid products. were made Intravenous challenge with 100mg of Hydrocortone Phosphate Injection produced dramatic confirmation of his history. But intravenous challenge with 100mg of Solu-Cortef, 6mg of dexamethasone disodium phosphate (Decadron Injection), 30mg of prednisolone disodium phosphate (Betnesol Injection) and 30mg of prednisolone sodium hemisuccinate (Predonine Soluble) and oral challenge test with 100mg of hydrocortisone (Hydrocortone Tablet) and 28mg methylprednisolone (Medrol Medulus) produced no adverse reactions. Skin tests using crude hydrocortisone disodium phosphate was negative and skin tests using its diluent were idiosyncratically positive. But on passive cutaneous anaphylaxy test using the skin of Japanese monkey, hydrocortisone disodium phosphate is positive and the diluent is negative. This type of adverse reaction of hydrocortisone administration is very important to clinical allergists, although the mechanism of this asthmatic attack was not clarified.
