What are the best corticosteroids (corticosteroids) for treating allergic reactions?

From the Guidelines

For treating allergic reactions, the most effective corticosteroid is prednisolone, with a recommended dose of 0.5 mg·kg−1·day−1 for 2 weeks, followed by 0.5 mg·kg−1·day−1 for alternate days for 8 weeks, as it has the most recent and highest quality evidence supporting its use 1. The choice of corticosteroid depends on the severity and type of allergic reaction, with higher potency steroids reserved for more severe reactions. Some key points to consider when prescribing corticosteroids for allergic reactions include:

• Oral corticosteroids such as prednisone and methylprednisolone are effective for acute severe allergic reactions, with methylprednisolone (40-125 mg IV) or dexamethasone (4-10 mg IV) often being first-line choices in emergency settings due to their rapid onset 1.
• Topical corticosteroids like hydrocortisone (1-2.5%) can be applied 2-4 times daily for localized skin reactions, while inhaled corticosteroids such as fluticasone or budesonide are preferred for allergic asthma or rhinitis 1.
• Corticosteroids work by suppressing inflammatory pathways and immune responses that drive allergic symptoms, and short-term use minimizes side effects, though patients should be monitored for adverse reactions including elevated blood glucose, mood changes, and increased susceptibility to infections 1.
• The most recent evidence suggests that prednisolone is the most effective corticosteroid for treating allergic reactions, with a recommended dose of 0.5 mg·kg−1·day−1 for 2 weeks, followed by 0.5 mg·kg−1·day−1 for alternate days for 8 weeks 1. It's also important to note that itraconazole increases the plasma levels of methylprednisolone but not prednisolone, and that therapeutic drug monitoring (TDM) should be performed to ensure optimal treatment outcomes 1.

From the FDA Drug Label

The following adverse reactions have been reported with prednisone or other corticosteroids: Allergic Reactions anaphylactoid or hypersensitivity reactions, anaphylaxis, angioedema Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy

The best corticosteroids for treating allergic reactions are not explicitly stated in the provided drug labels. However, prednisone is mentioned as a corticosteroid that can be used to treat allergic conditions, but it may also cause allergic reactions in some patients.

• Methylprednisolone and prednisone are both corticosteroids that can be used to treat various conditions, including allergic reactions.
• It is essential to note that corticosteroids can increase the risk of infection and should be used with caution in patients with certain medical conditions.
• The choice of corticosteroid and dosage should be determined by a healthcare professional based on the individual patient's needs and medical history 2, 3, 3.

From the Research

Corticosteroids for Allergic Reactions

• The best corticosteroids for treating allergic reactions are not clearly defined, as the choice of corticosteroid may depend on the individual patient's response and the severity of the reaction 4, 5.
• However, some studies suggest that phosphate-containing corticosteroids, such as dexamethasone and betamethasone, may be safer and more effective than succinate-containing corticosteroids, such as hydrocortisone and methylprednisolone, in patients with a history of allergic reactions to corticosteroids 5, 6.

Commonly Implicated Corticosteroids

• The most commonly implicated corticosteroids in allergic reactions are methylprednisolone and hydrocortisone, but reactions have also occurred with other corticosteroids, such as prednisone 7, 8.
• It is estimated that the overall prevalence of type I steroid hypersensitivity is around 0.3-0.5% 7.

Administration and Monitoring

• High doses of corticosteroids (> or = 500 mg) should be given over 30-60 minutes, and patients should be observed after administration for at least the same time period 8.
• Intravenous injection of succinate-containing corticosteroids in high-risk asthmatics should be performed slowly by drip injection under continuous monitoring 5.

Patient Risk Factors

• Patients with a history of aspirin allergy, atopic dermatitis, and stasis dermatitis of the lower extremities may be at higher risk for developing allergic reactions to corticosteroids 7, 6.
• Asthmatics, renal transplant patients, and hemodynamically unstable patients may also be at higher risk for adverse events 8.