From the Research
Prednisolone 20mg once daily for allergy management should generally be limited to the shortest duration possible, typically 5-7 days and rarely exceeding 14 days. Longer courses significantly increase the risk of serious side effects. When treating acute allergic reactions, a short "burst" therapy with a rapid taper is preferred over extended use. If symptoms require treatment beyond two weeks, the dose should be tapered gradually rather than stopped abruptly to prevent adrenal insufficiency, and alternative long-term allergy management strategies should be considered. Prolonged use of oral corticosteroids can cause numerous adverse effects including weight gain, mood changes, increased blood pressure, elevated blood sugar, osteoporosis, increased infection risk, and adrenal suppression. For chronic allergy management, other medications such as antihistamines, nasal corticosteroids, leukotriene modifiers, or immunotherapy are more appropriate for long-term use with better safety profiles, as supported by recent studies 1, 2, 3, 4, 5.
Some key points to consider when managing allergies include:
- Avoiding inciting allergens
- Using second-generation H1 antihistamines, intranasal antihistamines, or intranasal corticosteroids as first-line treatments for mild intermittent or mild persistent allergic rhinitis
- Considering alternative long-term allergy management strategies, such as immunotherapy, for patients with persistent moderate to severe allergic rhinitis
- Being aware of the potential side effects of oral corticosteroids, such as adrenal suppression, and taking steps to minimize these risks, as discussed in recent studies 4.
In terms of specific treatment options, intranasal corticosteroids have been shown to be effective in relieving nasal symptoms and improving quality of life in patients with allergic rhinitis, as demonstrated in a systematic review and meta-analysis 5. Additionally, a review of the safety of intranasal steroids found that they are generally well-tolerated, with few significant local or systemic side effects 4. Overall, the goal of allergy management should be to minimize symptoms and improve quality of life while minimizing the risk of adverse effects, and limiting the use of prednisolone 20mg once daily to the shortest duration possible is a key part of this approach.