From the Guidelines
For pediatric allergic urticaria, short courses of oral steroids, such as prednisone at 1-2 mg/kg/day (maximum 60 mg) for 3-5 days, may be used for severe or refractory cases. According to the guidelines for evaluation and management of urticaria in adults and children 1, oral corticosteroids should be restricted to short courses for severe acute urticaria. However, it's essential to note that the provided evidence primarily focuses on hidradenitis suppurativa, and the most relevant information for pediatric allergic urticaria comes from the 2007 guidelines 1.
When considering the use of steroids in pediatric patients, it's crucial to weigh the benefits against potential side effects, such as growth suppression, weight gain, mood changes, and increased susceptibility to infections. Steroids should be reserved for short-term use when antihistamines fail to provide adequate relief. The dose should be given in the morning to minimize adrenal suppression, and tapering is necessary if used for more than 5-7 days to prevent adrenal suppression.
Some key points to consider when using steroids for pediatric allergic urticaria include:
- Using the lowest effective dose to minimize side effects
- Limiting the duration of treatment to 3-5 days
- Tapering the dose when discontinuing treatment to prevent adrenal suppression
- Monitoring for potential side effects, such as growth suppression and increased susceptibility to infections
- Reserving steroids for severe or refractory cases where antihistamines are ineffective.
It's also important to note that topical steroids are generally not effective for urticaria, and alternative treatments, such as oral antihistamines, should be considered as first-line therapy. In emergency settings, methylprednisolone 1 mg/kg IV may be used for acute severe reactions.
From the FDA Drug Label
In pediatric patients, the initial dose of prednisolone sodium phosphate oral solution may vary depending on the specific disease entity being treated. The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day). The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses There is no direct information about the dosage of prednisolone for allergic urticaria in pediatric patients. However, based on the provided dosage range for other conditions, a conservative approach would be to consider a dose of 1-2 mg/kg/day in single or divided doses, but this is not directly supported by the label for allergic urticaria 2.
From the Research
Pediatric Steroid for Allergic Urticaria
- The use of steroids in pediatric patients with allergic urticaria is a topic of interest, with various studies examining the effectiveness of corticosteroids in managing the condition 3, 4, 5.
- According to a study published in 2020, chronic urticaria in pediatric patients can have a significant impact on quality of life and healthcare costs, emphasizing the need for effective treatment strategies 3.
- A 2010 study found that a short course of oral prednisone can be effective in inducing remission in patients with antihistamine-resistant chronic urticaria, with nearly 50% of patients responding to the treatment 4.
- Another study published in 1995 examined the use of prednisone in the outpatient management of acute urticaria, finding that the addition of a prednisone burst improved symptomatic and clinical response to antihistamines 5.
- However, it is essential to note that the use of steroids in pediatric patients should be guided by established guidelines and expert recommendations, as the overutilization of sedating antihistamines and oral steroids can be a concern 3.
- There is limited information available on the specific use of pediatric steroids for allergic urticaria, and more research is needed to inform evidence-based practice in this area.
- The study published in 1979 is not relevant to the topic of pediatric steroid for allergic urticaria 6.