What is the recommended dosage of prednisone (corticosteroid) for treating allergies?

Prednisone Treatment for Allergies

For treating allergic reactions, prednisone should be dosed at 0.5-1 mg/kg/day (maximum 60 mg) for mild to moderate allergic reactions, and continued for 2-3 days after symptom resolution. 1, 2

Dosing Guidelines by Severity

Mild to Moderate Allergic Reactions

• Initial dose: 0.5-1 mg/kg/day orally (maximum 60 mg/day)
• Duration: 2-3 days after symptom resolution
• Administration: Take in the morning with food to minimize gastric irritation 2
• Taper: Not typically required for short courses

Severe Allergic Reactions/Anaphylaxis

• First-line treatment is ALWAYS epinephrine, not prednisone
• Prednisone is adjunctive therapy only after epinephrine administration
• Dose: 1 mg/kg (maximum 60-80 mg) 1
• Duration: Continue for 2-3 days after discharge 1

Important Clinical Considerations

Mechanism of Action

• Prednisone works through anti-inflammatory effects
• Suppresses recruitment of inflammatory cells and release of mediators from mast cells 1
• Not effective for immediate symptom relief - onset of action takes hours

Efficacy Evidence

• In antihistamine-resistant chronic urticaria, a short course of prednisone (starting at 25 mg/day for 3 days) induced remission in nearly 50% of patients 3
• A single 20 mg dose of prednisolone significantly reduced leucocyte infiltration and the magnitude of cutaneous late-phase allergic reactions 4

Common Pitfalls to Avoid

1. Never use prednisone as first-line treatment for anaphylaxis

   • Epinephrine is always first-line for anaphylaxis 1
   • Prednisone has delayed onset and will not prevent immediate life-threatening symptoms

2. Avoid prolonged courses without tapering

   • Short courses (2-3 days) generally don't require tapering
   • Longer courses should be tapered to prevent adrenal suppression 2

3. Be aware of steroid allergies

   • Though rare, allergic reactions to corticosteroids can occur 5, 6
   • Consider alternative treatments if patient has history of steroid allergy

Special Populations

Children

• Dosing: 1-2 mg/kg/day (maximum 60 mg) for 5 days 7
• For allergic asthma exacerbations, both prednisone and dexamethasone are effective 7

Pregnant Women

• Use lowest effective dose for shortest duration
• Benefits usually outweigh risks for severe allergic reactions

Follow-up Recommendations

• Evaluate response within 24-48 hours
• Consider referral to allergist for identification of triggers and long-term management
• If symptoms persist despite appropriate prednisone dosing, consider alternative diagnoses or additional therapies

Remember that while prednisone is effective for treating allergic reactions, it should be used judiciously and as part of a comprehensive treatment approach that includes trigger avoidance and appropriate use of antihistamines.