From the FDA Drug Label
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
- Pediatric dosing: The recommended dose for pediatric patients is 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day)
- Hives treatment: Although the label does not explicitly mention hives, it does provide dosing information for pediatric patients, which can be applied to various conditions, including hives.
- Prednisone or prednisolone: Both prednisone and prednisolone can be used in pediatric patients, with the same dosing recommendations of 1–2 mg/kg/day in single or divided doses, as per the NHLBI guidelines 1. The choice between prednisone and prednisolone for pediatric hives would depend on the individual patient's needs and the clinical judgment of the healthcare provider.
From the Research
Prednisolone is the preferred choice over prednisone for treating pediatric hives due to its direct activity and availability in liquid form, which allows for more precise dosing based on weight. The recommended dosage is typically 1-2 mg/kg/day of prednisolone (maximum 60 mg daily) for 3-5 days 2. This preference is based on the most recent and highest quality study available, which emphasizes the importance of effective and safe treatment options for pediatric patients 2. Key considerations in the management of pediatric hives include:
- Using first-generation antihistamines like diphenhydramine or second-generation options like cetirizine as the initial treatment approach
- Reserving steroids for severe or persistent cases that do not respond adequately to antihistamines
- Administering prednisolone in the morning to minimize adrenal suppression and sleep disturbances
- Informing parents about common side effects, such as increased appetite, mood changes, and stomach upset
- Limiting the use of steroids to short durations when possible to avoid temporarily suppressing the immune system's overreaction causing the hives 3, 4, 2. It's also important to note that while other treatment options like cyclosporine and dupilumab are effective, their use may be restricted due to high cost and limited availability in certain settings 2.