What is the recommended dose of prednisone (corticosteroid) for an allergic reaction?

Prednisone Dosing for Allergic Reactions

For allergic reactions, prednisone should be dosed at 1 mg/kg with a maximum dose of 60-80 mg orally for 2-3 days. 1, 2

Standard Dosing by Setting

Hospital Setting

• Prednisone at 1 mg/kg with a maximum dose of 60-80 mg orally 1
• Alternatively, methylprednisolone at 1 mg/kg with a maximum dose of 60-80 mg IV for severe cases 1
• Remember that corticosteroids are adjunctive therapy and should never be used alone in the treatment of anaphylaxis 1

Outpatient Setting

• Prednisone daily for 2-3 days following discharge 1, 2
• For less critical allergic episodes, oral prednisone at 0.5 mg/kg may be sufficient 1

Dosing Algorithm Based on Severity

Mild Allergic Reactions

• H1 and H2 antihistamines are the primary treatment 2
• If symptoms progress or there's history of prior severe reactions, epinephrine should be administered promptly 2

Moderate to Severe Allergic Reactions

• For moderate to severe allergic reactions, prednisone is recommended as adjunctive therapy after epinephrine 2
• Dosing at 1 mg/kg daily (maximum 60-80 mg) 1, 2
• Duration of 2-3 days is typically sufficient 1, 2

Special Populations

Children

• Weight-based dosing: 1 mg/kg daily (maximum 60 mg) 2
• Same 2-3 day duration applies for allergic reactions in children 2

Elderly or Patients with Comorbidities

• Lower doses may be appropriate to minimize adverse effects 2
• Consider potential drug interactions and comorbidities that might be exacerbated by corticosteroids 2

Important Considerations and Caveats

• Short-term prednisone courses (2-3 days) for allergic reactions typically don't require tapering 2
• Common side effects with short-term use include increased appetite, mood changes, and insomnia 2
• For patients with severe or extensive allergic contact dermatitis (>20% body surface area), systemic steroid therapy is often required 3
• In severe poison ivy dermatitis (rhus dermatitis), oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 3
• For antihistamine-resistant chronic urticaria, a short course of prednisone (starting with 25 mg/day for 3 days) has shown effectiveness in nearly 50% of patients 4
• Be aware that allergic reactions to corticosteroids themselves are possible, though rare 5, 6
• High doses of corticosteroids (≥500 mg) should be given over 30-60 minutes with patient observation afterward 6

Follow-up Care

• After an allergic reaction treated with prednisone, patients should follow up with their primary care provider 2
• Consider referral to an allergist, especially for severe or recurrent reactions 2
• Patients should be educated on allergen avoidance and early recognition of symptoms 2