What is the recommended dosage of prednisone for severe seasonal allergies?

Prednisone is Not Recommended for Severe Seasonal Allergies

Intranasal corticosteroids, not oral prednisone, are the recommended first-line treatment for severe seasonal allergies due to their superior efficacy and safety profile. 1, 2

First-Line Treatment Options

Intranasal Corticosteroids

• Most effective medication class for controlling allergic rhinitis symptoms 2
• Recommended as monotherapy for initial treatment 1
• Dosing: 2 sprays per nostril once daily initially, can reduce to 1 spray per nostril daily for maintenance 2
• Regular use is more effective than as-needed use 2
• FDA-approved options:
  • Fluticasone propionate (Flonase) for ages ≥4 years
  • Mometasone furoate (Nasonex) for ages ≥2 years
  • Fluticasone furoate (Veramyst) for ages ≥2 years

For Moderate to Severe Symptoms

• Combination of intranasal corticosteroid and intranasal antihistamine may be recommended for initial treatment in persons aged 12 years or older 1, 2
• This combination provides >40% relative improvement versus monotherapy 2

Second-Line Options

Leukotriene Receptor Antagonists

• Less effective than intranasal corticosteroids for nasal symptom reduction 1, 2
• May be considered for patients who cannot tolerate intranasal medications 2
• Beneficial for patients with concurrent mild persistent asthma 1, 2

Oral Antihistamines

• Less effective than intranasal corticosteroids, particularly for nasal congestion 2
• First-generation antihistamines should be avoided due to sedating effects 2

Why Oral Prednisone is Not Recommended

Despite the question asking about prednisone dosage, systemic corticosteroids like prednisone are not recommended as standard treatment for seasonal allergies due to:

1. Potential for significant adverse effects 2
2. Availability of safer, effective alternatives (intranasal corticosteroids)
3. Risk of adrenocortical suppression with prolonged use 3

The 2017 Joint Task Force on Practice Parameters does not include oral corticosteroids in their recommendations for seasonal allergic rhinitis 1.

Limited Role of Systemic Corticosteroids

Systemic corticosteroids may only be considered in very specific circumstances:

• For severe, refractory cases not responding to standard therapies 4
• When nasal blockage is the predominant symptom 4
• For short-term use only

Important Cautions

• Avoid intramuscular or parenteral corticosteroid injections due to potential significant side effects 2
• Avoid single or recurrent administration of parenteral corticosteroids due to potential long-term side effects 2
• If oral corticosteroids are absolutely necessary, they should be used for the shortest duration possible

Treatment Algorithm for Severe Seasonal Allergies

1. First step: Intranasal corticosteroid monotherapy
2. If inadequate response: Add intranasal antihistamine
3. If still inadequate: Consider leukotriene receptor antagonist or oral antihistamine
4. For refractory cases only: Consider short course of oral corticosteroids as a last resort, under medical supervision

Remember that intranasal corticosteroids remain the cornerstone of treatment for most patients with allergic rhinitis, including those with severe symptoms 2.