What is the dose of corticosteroids (cortico-steroids) for an allergic reaction?

Corticosteroid Dosing for Allergic Reactions

For allergic reactions, adults should receive prednisone 40-60 mg daily for 2-3 days, while children should receive 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days. 1

Adult Dosing

Oral Administration

• Prednisone: 40-60 mg daily for 2-3 days 1
• Can be given as a single dose or divided into 2 doses 2

Intravenous Administration

• Hydrocortisone: 200 mg IV (for acute management) 1, 2
• Methylprednisolone: Equivalent to prednisone but at 80% of the dose (approximately 32-48 mg) 3

Pediatric Dosing

Based on Weight

• Prednisone/prednisolone: 1-2 mg/kg/day in 2 divided doses 2, 1
• Maximum dose: 60 mg/day 2
• Duration: 3-10 days 2

Based on Age

• 12 years: Similar to adult dosing (40-60 mg daily) 1

• 6-12 years: Typically 20-30 mg daily 1
• <6 years: Typically 10-20 mg daily (based on weight) 1

Administration Considerations

Duration of Treatment

• Short course or "burst" therapy: 3-10 days 2
• Continue until symptoms resolve 2
• For courses less than 1 week, no need to taper the dose 2
• For courses up to 10 days, tapering is generally unnecessary if patients are concurrently taking inhaled corticosteroids 2

Route of Administration

• For most allergic reactions, oral administration is preferred 2
• No advantage for IV administration over oral therapy unless gastrointestinal absorption is impaired 2
• For severe reactions (anaphylaxis), IV hydrocortisone 200 mg should be given after epinephrine 1, 2

Special Considerations

Anaphylaxis Management

1. Epinephrine is the first-line treatment (not corticosteroids) 1
2. Corticosteroids are adjunctive therapy and may help prevent biphasic reactions 2
3. For severe anaphylaxis, consider doubling the usual hydrocortisone dose for 48 hours 1

Cautions

• Be aware of rare hypersensitivity reactions to corticosteroids themselves 4, 5, 6, 7, 8
• If a patient has a known allergy to one corticosteroid, they may tolerate those from other groups 4
• Patients with asthma may be at higher risk for corticosteroid hypersensitivity reactions 5

Follow-up

• Monitor patients for at least 4-6 hours after initial symptoms resolve 1
• For patients with severe reactions, consider referral to an allergist-immunologist 1
• Provide patients with an anaphylaxis emergency action plan if appropriate 1

Remember that while corticosteroids are important in managing allergic reactions, they have a slow onset of action and should not replace epinephrine as the first-line treatment for anaphylaxis.