Is prednisone (corticosteroid) effective for treating severe allergic rhinitis?

Prednisone for Severe Allergic Rhinitis

A short course (5-7 days) of oral prednisone may be appropriate for treating very severe or intractable allergic rhinitis symptoms when other treatments have failed, but should not be used as routine therapy due to potential systemic side effects. 1

Indications for Oral Prednisone in Allergic Rhinitis

• Oral corticosteroids like prednisone should be reserved for patients with severe, intractable nasal symptoms that are unresponsive to other treatment modalities 1
• Prednisone is FDA-approved for "control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment" including seasonal or perennial allergic rhinitis 2
• Short courses (5-7 days) of oral prednisone may be appropriate when symptoms are extremely severe and significantly impact quality of life 1

Treatment Algorithm for Allergic Rhinitis

First-line therapies (try these before considering prednisone):

• Intranasal corticosteroids are the most effective medication class for controlling all four major symptoms of allergic rhinitis (sneezing, itching, rhinorrhea, and nasal congestion) 1
• Second-generation oral antihistamines are effective for symptom relief with less sedation than first-generation options 1
• Intranasal antihistamines have a rapid onset of action and can be effective for episodic symptoms 1
• Leukotriene receptor antagonists (e.g., montelukast) may be used, though they are generally less effective than intranasal corticosteroids 1

Second-line therapies:

• Combination therapy with intranasal corticosteroid plus intranasal antihistamine may be more effective than either agent alone for moderate to severe symptoms 1
• Intranasal cromolyn sodium can be effective for some patients, particularly if started before symptoms become severe 1
• Intranasal anticholinergics may help reduce rhinorrhea but have minimal effect on other nasal symptoms 1

When to consider prednisone (last resort):

• Only after failure of the above therapies
• For very severe, intractable nasal symptoms 1
• For significant nasal polyposis 1
• Limited to short courses (5-7 days) to minimize adverse effects 1

Important Cautions and Considerations

• Single administration of parenteral corticosteroids is discouraged, and recurrent administration is contraindicated due to greater potential for long-term side effects 1
• Potential for adrenal suppression should be considered in any patient receiving oral corticosteroids 1
• Oral corticosteroids should not be administered as therapy for chronic rhinitis except in rare cases 1
• In children, intranasal corticosteroids should be used at the lowest effective dose before considering systemic options 1, 3
• The combination of desloratadine (antihistamine) plus prednisolone has been shown effective for acute symptoms of allergic rhinitis in children, with fewer adverse events than some other combinations 4

Conclusion

While prednisone is effective for controlling severe allergic rhinitis symptoms, its use should be limited to short courses for severe, intractable cases due to potential systemic side effects. Intranasal corticosteroids remain the cornerstone of treatment for allergic rhinitis, with better safety profiles for long-term management 5, 6.