Steroid sensitivity in Samter's

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Some authors have reported that a small minority of Samter's patients react to systemic steroids, ie that they create bronchoconstriction instead of relieving their symptoms.In this correspondence,CorrespondenceHypersensitivity to systemic corticosteroids in aspirin-sensitive patients with asthmaAndrzej Szczeklik MD, PhDDepartment of Medicine, Jagiellonian University Medical College, Krakow, Polandauthor Andrzej Sczezklik quotes a japanese team offering an explanation : An interesting explanation was suggested by Taniguchi and Sato,7

who challenged a group of 20 aspirin-sensitive asthmatic patients with various glucocorticosteroid esters and observed cross-sensitivity with succinate esters. Accordingly, bronchoconstriction could be precipitated

by succinate salts of both hydrocortisone and methylprednisone, but not

by the phosphate salts.In other words, it is not the steroid prednisone itself that causes the steroid sensitivity, but it may be the salt to which it is bound, in this case succinate salts.Perhaps switching to other salts of the same steroids would not give any adverse reaction at all.