Options After An Allergy To Pulmicort

In our latest question and answer, the pharmacist discusses concerns someone has regarding their allergy to Pulmicort.

Question

My dad took Pulmicort nebulizer solution this morning but had a reaction. Can he go back to his Advair tonight?

Asked by MPK On Feb 05, 2024

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Feb 05, 2024
Last updated Mar 17, 2024

Key points

  • It is difficult to determine cross-sensitivity to corticosteroids, like budesonide (in Pulmicort) and fluticasone (in Advair).
  • Without an allergy evaluation or challenge, it's not possible to determine a safe alternative glucocorticoid for someone who has had an immediate reaction to a specific agent.
  • If you've previously tolerated a specific corticosteroid well, it's likely still safe for you to take it.

Answer

Thank you for reaching out! I'm sorry to hear about your dad's reaction to the Pulmicort nebulizer solution.

Based on the information you've provided, it's important to consider the nature and severity of his reaction, as well as his previous experience with Advair.

Discussion Regarding Pulmicort Allergy And Cross-Sensitivity

Pulmicort and Advair both contain corticosteroids. Pulmicort contains budesonide, and Advair contains fluticasone along with salmeterol (a long-acting beta agonist).

While corticosteroids share similarities in their chemical and structural composition, they can have different effects on the body, leading to varying clinical outcomes.

Cross-sensitivity between corticosteroids is complex. There have been reports of cross-reactivity based on chemical structures, but establishing definitive conclusions about patterns of cross-reactivity is challenging. Some individuals may exhibit no cross-reactivity, while others may be allergic to more than one systemically administered corticosteroid.

Without an allergy evaluation or challenge procedure, it is not possible to determine a "safe" alternative corticosteroid empirically for an individual who has had an immediate reaction to a specific agent.

Therefore, if your dad has experienced an allergic reaction to Pulmicort, it is advisable to seek evaluation by an allergy specialist. They can provide a comprehensive assessment and advise on the best course of action.

Options

If your dad had a reaction to Pulmicort and has not used other steroids in the past, I'd recommend avoiding systemic use of all corticosteroids until he has been evaluated. There are procedures, such as a graded challenge, that can help select a different agent.

However, since your dad has (I'm assuming here) safely taken Advair in the past with no issues, it would likely be safe to go back to it, as he has shown to tolerate it well.

If your dad has not done so already, be sure he discusses the reaction he had with his doctor for future guidance.

Final Words

I hope this answer was helpful, and please reach back out anytime.

References

  • Corticosteroid allergy in asthma, PubMed
  • Allergic-type reactions to corticosteroids, PubMed
  • Corticosteroid cross-reactivity: clinical and molecular modelling tools, PubMed
  • Hypersensitivity reactions to corticosteroids, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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