From the Guidelines
Corticosteroid dosage should be continued for a short period in anaphylaxis, as they may help prevent biphasic or protracted reactions.
Rationale
- The use of corticosteroids in anaphylaxis is empiric and prevalent, despite limited evidence to support or refute their use 1.
- Corticosteroids are not helpful in the acute treatment of anaphylaxis due to their slow onset of action (4 to 6 hours) 1.
- However, they may help prevent biphasic or protracted reactions, which occur in up to 20% of individuals 1.
- Treatment with corticosteroids should be stopped within 2 to 3 days, as all biphasic reactions reported to date have occurred within 3 days 1.
- The recommended dosage of corticosteroids is 1.0-2.0 mg/kg/day of methylprednisolone, administered every 6 hours 1.
- Oral administration of prednisone, 0.5 mg/kg, might be sufficient for less critical anaphylactic episodes 1.
From the Research
Corticosteroid Dosage in Anaphylaxis
- The use of corticosteroids in the treatment of anaphylaxis is a topic of debate, with some studies suggesting that they may not be effective in preventing biphasic anaphylaxis 2, 3.
- A systematic review of 31 studies found that corticosteroids did not prevent biphasic anaphylaxis, and their use was not recommended due to potential adverse effects 2.
- Another review of 2496 reports found no evidence to support the use of steroids in the emergency management of anaphylaxis 3.
- However, a review of 30 original research papers found that corticosteroids may reduce the length of hospital stay, but did not reduce revisits to the emergency department 4.
- The use of corticosteroids in anaphylaxis is often recommended in guidelines, but the evidence to support their use is limited 5, 6.
Administration of Corticosteroids
- Corticosteroids are often administered after epinephrine in the treatment of anaphylaxis 5, 6.
- The exact timing and dosage of corticosteroids in anaphylaxis is not well established, and more research is needed to determine their effectiveness 4.
- Some studies suggest that corticosteroids may have a quicker response when administered within 5 to 30 minutes of anaphylaxis onset, but this is not consistently supported by the evidence 4.
Biphasic Anaphylaxis
- Biphasic anaphylaxis is a recurrence of anaphylactic symptoms after initial resolution, and can occur in up to 20% of cases 2.
- The use of corticosteroids to prevent biphasic anaphylaxis is not supported by the evidence, and their effectiveness in reducing the risk of biphasic reactions is unclear 2, 4.
- Patients should be monitored for biphasic reactions for 4 to 12 hours after anaphylaxis, depending on risk factors for severe anaphylaxis 6.