From the Guidelines
Corticosteroid injections for allergic reactions in pediatric patients are not recommended as a first-line treatment due to potential risks and side effects, and instead, oral antihistamines and nasal steroid sprays should be considered as initial therapy. The use of corticosteroid injections in children should be approached with caution, as they can have a longer duration of action in the body, making side effects more difficult to reverse compared to oral or inhaled formulations 1.
Alternative Treatment Options
Some alternative treatment options for allergic reactions in children include:
- Oral antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) at age-appropriate doses
- Nasal steroid sprays such as fluticasone (Flonase) for nasal symptoms
- Identifying and avoiding triggers
- Using saline nasal rinses
- Considering allergen immunotherapy for long-term management
Risks and Side Effects
The potential risks and side effects of corticosteroid injections in children include:
- Growth suppression
- Adrenal insufficiency
- Localized tissue damage
- Mood changes
- Increased appetite
- Facial swelling
Recommended Approach
The recommended approach for treating allergic reactions in children is to use oral antihistamines and nasal steroid sprays as initial therapy, and to reserve corticosteroid injections for severe cases or when other treatments have failed 1. If corticosteroid injections are deemed necessary, they should only be administered by healthcare providers experienced in pediatric care, and parents should monitor for side effects.
Evidence-Based Recommendations
The evidence-based recommendations for treating allergic reactions in children are based on studies that have shown the effectiveness of oral antihistamines and nasal steroid sprays in reducing symptoms and improving quality of life 1. Additionally, studies have shown that corticosteroid injections can have potential risks and side effects, and should be used with caution in pediatric patients 1.
From the FDA Drug Label
The efficacy and safety of corticosteroids in the pediatric population are based on the well-established course of effect of corticosteroids which is similar in pediatric and adult populations Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephrotic syndrome (>2 years of age), and aggressive lymphomas and leukemias (>1 month of age). Other indications for pediatric use of corticosteroids, e.g., severe asthma and wheezing, are based on adequate and well-controlled trials conducted in adults, on the premises that the course of the diseases and their pathophysiology are considered to be substantially similar in both populations. The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS) Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity.
The effects of corticosteroid injections for allergic reactions in pediatric patients are not directly addressed in the provided drug label. However, the label does mention that corticosteroids can be used in pediatric patients for certain conditions, such as nephrotic syndrome, aggressive lymphomas and leukemias, severe asthma, and wheezing.
- The adverse effects of corticosteroids in pediatric patients are similar to those in adults.
- Growth velocity may be decreased in pediatric patients treated with corticosteroids.
- Pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis 2.
From the Research
Effects of Corticosteroid Injections on Allergic Reactions in Pediatric Patients
- The goal of treatment in pediatric allergic rhinitis is to provide effective prevention of or relief from allergic rhinitis symptoms as safely and effectively as possible 3.
- Intranasal corticosteroids have been shown to be the most effective form of pharmacologic treatment for allergic rhinitis, with an improved risk-benefit ratio compared to older corticosteroids 3.
- Oral corticosteroids are very effective but can have unwanted systemic effects, whereas intranasal corticosteroids have a lower risk of systemic side effects 3, 4.
- A study on triamcinolone acetonide aqueous nasal spray found no significant effects on adrenocortical function in pediatric patients with allergic rhinitis, indicating minimal risk of suppression of adrenocortical function 5.
Treatment Strategies for Allergic Rhinitis in Children
- A tripartite treatment strategy that includes environmental control, immunotherapy, and pharmacologic treatment is recommended for managing allergic rhinitis in children 6.
- Intranasal corticosteroids and oral or topical antihistamines are the mainstay of pharmacologic therapy for allergic rhinitis, depending on the severity of the condition 6, 4.
- Immunotherapy has been shown to be potentially prophylactic, capable of altering the course of allergic rhinitis, and is considered a key component of treatment strategy 6.
Safety and Efficacy of Intranasal Corticosteroids
- Intranasal corticosteroids are accepted as safe and effective first-line therapy for allergic rhinitis, with several available options, including beclomethasone dipropionate, budesonide, and mometasone furoate 3, 4.
- Adverse reactions to intranasal corticosteroids are usually limited to the nasal mucosa, such as dryness, burning, and stinging, and are generally mild and well-tolerated 4.
- Studies have shown that intranasal corticosteroids can relieve nasal congestion, itching, rhinorrhea, and sneezing, and can prevent late-phase symptoms of allergic rhinitis 4.