From the Guidelines
Methylprednisolone is recommended for pediatric anaphylaxis at a dose of 1-2 mg/kg IV (maximum 125 mg), typically administered after epinephrine, which remains the first-line treatment. For children, the appropriate methylprednisolone dosing should be calculated based on weight, with administration occurring as soon as possible after initial epinephrine treatment and stabilization of airway, breathing, and circulation. While methylprednisolone won't reverse the immediate anaphylactic reaction, it helps prevent biphasic or prolonged reactions by reducing inflammation and suppressing immune responses.
The use of methylprednisolone in pediatric anaphylaxis is supported by the most recent guidelines, including the 2020 practice parameter update, systematic review, and grading of recommendations, assessment, development and evaluation (GRADE) analysis 1. Although the evidence for the use of antihistamines and glucocorticoids in preventing biphasic anaphylaxis is low, these agents may still be considered as secondary therapy in anaphylaxis treatment 1.
It should be followed by oral prednisone or prednisolone at 1-2 mg/kg/day (maximum 60 mg/day) for 3-5 days to prevent symptom recurrence. Remember that corticosteroids like methylprednisolone are adjunctive therapy only; epinephrine (0.01 mg/kg of 1:1000 solution, maximum 0.5 mg) remains essential as the primary life-saving intervention for anaphylaxis 1. After the acute episode resolves, patients should be prescribed an epinephrine auto-injector, educated on anaphylaxis management, and referred to an allergist to identify triggers and develop a comprehensive management plan.
Key considerations in the management of pediatric anaphylaxis include:
- Prompt administration of epinephrine as the first-line treatment
- Calculation of the appropriate dose of methylprednisolone based on the child's weight
- Administration of methylprednisolone as soon as possible after initial epinephrine treatment and stabilization of airway, breathing, and circulation
- Use of antihistamines and glucocorticoids as secondary therapy, if necessary
- Education on anaphylaxis management and referral to an allergist for follow-up evaluation.
From the FDA Drug Label
In pediatric patients, the initial dose of methylprednisolone may vary depending on the specific disease entity being treated. The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone, or methylprednisolone in pediatric patients whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1 mg/kg/day to 2 mg/kg/day in single or divided doses
The FDA drug label does not provide a specific dosage recommendation for methylprednisolone in pediatric anaphylaxis.
- Key points:
From the Research
Methylprednisolone in Pediatric Anaphylaxis
- The use of methylprednisolone in pediatric anaphylaxis is not directly addressed in the provided studies, but the role of corticosteroids in anaphylaxis management is discussed.
- According to 3, patients who received prehospital corticosteroids were more likely to require intravenous fluids in the emergency department and be admitted, suggesting that corticosteroid use in anaphylaxis should be revisited.
- The studies consistently emphasize the importance of epinephrine as the first-line treatment for anaphylaxis, with antihistamines and corticosteroids considered second-line medications 4, 5, 6, 7.
- In the management of anaphylaxis, the focus is on rapid diagnosis, assessment, and early initiation of therapy, with epinephrine administration being the priority 6, 7.
- Additional interventions, such as oxygen therapy, fluid resuscitation, beta-agonists, antihistamines, and corticosteroids, may be considered, but should not delay the administration of epinephrine 6, 7.