What is the recommended dose of prednisone for an adult and child with an anaphylaxis reaction for discharge?

Prednisone Dosing for Anaphylaxis at Discharge

For patients with anaphylaxis requiring discharge, prednisone should be prescribed at a dose of 1-2 mg/kg daily for 2-3 days for both adults and children. 1

Adult Dosing

• Adult dose: Typically 40-60 mg daily for 2-3 days 2, 1
• This is equivalent to the IV hydrocortisone 200 mg used during acute management 2

Pediatric Dosing

• Children: 1-2 mg/kg daily for 2-3 days 1
• Maximum dose generally should not exceed adult dosing
• Age-based considerations:

  • 12 years: Similar to adult dosing (based on weight)

  • 6-12 years: Typically 20-30 mg daily
  • <6 years: Typically 10-20 mg daily (based on weight)

Administration Guidelines

• Oral prednisone should be continued for 2-3 days after discharge 2
• No tapering is typically required for this short course
• Should be taken with food to minimize gastrointestinal side effects

Comprehensive Discharge Plan

1. First-line medication: Epinephrine auto-injector prescription and training

   • 25 kg: 0.3 mg auto-injector

   • 10-25 kg: 0.15 mg auto-injector 2

2. Adjunctive medications:

   • H1 antihistamine: Diphenhydramine 1-2 mg/kg (max 50 mg) every 6 hours for 2-3 days
   • Alternative: Non-sedating second generation antihistamine
   • H2 antihistamine: Ranitidine twice daily for 2-3 days
   • Corticosteroid: Prednisone daily for 2-3 days 2, 1

3. Follow-up:

   • Arrange appointment with primary care provider
   • Consider referral to allergist/immunologist 2

Important Considerations

• Corticosteroids are not effective for the acute management of anaphylaxis but are prescribed to prevent biphasic or protracted reactions 2, 1
• While there is limited data supporting their use in preventing biphasic reactions, they remain standard of care 2
• Patients should be monitored for at least 4-6 hours after initial symptoms resolve before discharge 1
• Patients with severe reactions or who required multiple doses of epinephrine should be observed longer due to risk of biphasic reactions 1

Special Situations

• For patients with frequent or severe episodes, longer courses of prednisone may be required
• For corticosteroid-dependent idiopathic anaphylaxis, maintenance therapy with prednisone may be necessary, with doses ranging from 15-65 mg every other day 3

Remember that while corticosteroids are important for preventing biphasic reactions, epinephrine remains the critical life-saving medication for anaphylaxis, and patients must be educated on its prompt use for future episodes.