背景：药物引起的IV型反应的皮肤表现差异很大，与对称的药物相关的中间和弯曲性皮疹（SDRIFE）不太常见。皮质类固醇（CS），主要以其抗炎作用而闻名，很少引起超敏反应。
目的：本病例系列的目的是报告4例全身泼尼松龙治疗后的SDRIFE病例，并回顾现有的CS分类建议，以更好地了解CS的交叉反应性。
方法：在德国皮肤病学中心招募的患者接受了变态反应学评估，包括用各种CS进行点刺和斑贴试验。阳性病例接受了替代药物的口服激发测试。Coopman等人的分类系统。和Baeck等人。被考虑在内。
结论：尽管文献很少，CS诱导的IV型反应确实发生，包括SDRIFE。基于化学结构的分类系统提供了对交叉反应性模式的洞察。使用替代CS的激发测试突出了管理CS超敏反应的复杂性。
结论：SDRIFE可能在全身泼尼松龙治疗后发展。分类系统有助于理解交叉反应性，并有助于选择替代制剂，但并不总是可靠的。个性化评估对于管理CS超敏反应至关重要，在必要时考虑替代剂和紧急使用CS。
BACKGROUND: Cutaneous manifestations of drug-induced type IV reactions vary widely, with symmetrical drug-related intertriginous and flexural exanthema (
SDRIFE) being a less common presentation. Corticosteroids (CS), primarily known for their anti-inflammatory effects, rarely induce hypersensitivity reactions.
OBJECTIVE: The aim of this case series is to report four cases of
SDRIFE following systemic prednisolone therapy and to
review existing CS classification proposals to better understand cross-reactivity of CS.
METHODS: Patients recruited at a German dermatology centre underwent allergologic evaluation including prick and patch testing with various CS. Positive cases underwent oral challenge testing with alternative agents. The classification systems of Coopman et al. and Baeck et al. were taken into account.
CONCLUSIONS: Despite a paucity of literature, CS-induced type IV reactions do occur, including
SDRIFE. Classification systems based on chemical structure provide insight into cross-reactivity patterns. Provocation tests with alternative CS highlight the complexity of managing CS hypersensitivity.
CONCLUSIONS: SDRIFE may develop following systemic prednisolone therapy. Classification systems are helpful in understanding cross-reactivity and help in the selection of alternative preparations but are not always reliable. Individualised assessment is crucial for managing CS hypersensitivity, with consideration of alternative agents and emergency use of CS when necessary.
