Immediate allergic hypersensitivity reactions (anaphylactic shock) to intramuscular dexamethasone in an asthmatic child: a case report

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INTRODUCTION: Glucocorticoids are essential in treating various conditions due to their immunosuppressive, anti-inflammatory, and antiallergenic properties. However, they can cause hypersensitivity reactions that may go undiagnosed. Recognizing corticosteroid hypersensitivity is crucial, as demonstrated by a case in which a patient with asthma experienced severe anaphylaxis after receiving dexamethasone. CASE PRESENTATION: A 5-year-old Egyptian male with asthma was admitted with severe symptoms, including shortness of breath, low oxygen saturation, and tachycardia. After initial treatment with nebulized medications, he was given intramuscular dexamethasone but quickly developed severe anaphylaxis, characterized by rash, angioedema, and anaphylactic shock. Immediate treatment with epinephrine, oxygen (intubation), saline, and cetirizine was administered, and the patient stabilized after a second dose of epinephrine. Following 24 hours of observation, his condition improved, and we discussed safe alternatives with a clinical pharmacist. CONCLUSION: Steroid-induced allergic reactions, although rare, can lead to life-threatening conditions such as anaphylaxis, as illustrated in this case.

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