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Allergic or Pseudoallergic Reaction Following Epidural Steroid Deposition and Skin Testing
  1. Dana L. Simon, M.D.,
  2. Veljko Zivkovich, M.D.,
  3. Roger D. Kunz, M.D. and
  4. James D. German, D.O.
  1. From the Mercy Hospital Nerve Block Center, Department of Anesthesiology, Mercy Hospital Medical Center, and the Department of Pediatrics, Division of Allergy and Pulmonology, Iowa Methodist Hospital Medical Center, Des Moines, Iowa.


A 46-year-old female with a history of low back pain and sciatica was referred for evaluation for epidural steroid injection. Following appropriate history, physical examination and laboratory testing, an epidural injection was performed using triamcinolone diacetate (Aristocort Intralesional (R), Lederle Pharmaceuticals) and lidocaine. Despite good pain relief, the patient presented one week later to a hospital emergency room with signs and symptoms consistent with a delayed allergic or pseudoallergic reaction. Subsequent skin testing, performed one month following the epidural injection, with the same drug precipitated the onset of an accelerated but similar reaction 12 hours later. To our knowledge, this is the first known report of allergic or pseudoallergic reactions following epidural steroid deposition and subsequent skin testing in the medical literature.

  • Epidural steroid injection
  • low back pain
  • sciatica
  • allergy
  • pseudoallergy anaphylaxis

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