What is the typical dosage of prednisone (corticosteroid) for treating allergies in adults and children?

Prednisone Dosing for Allergic Reactions

For adults with allergic reactions, use prednisone 40-60 mg orally once daily (or divided into two doses) for 2-3 days; for children, use 1-2 mg/kg/day (maximum 60 mg/day) for 2-3 days. 1

Adult Dosing

Acute Allergic Reactions and Anaphylaxis

• Administer prednisone 1 mg/kg orally (maximum 60-80 mg) as a single dose or divided into two doses for 2-3 days after discharge from the emergency department or hospital. 1, 2
• The typical adult dose is 40-60 mg daily for outpatient management, which can be given as a single morning dose or split into two divided doses. 1
• For severe reactions requiring hospitalization, methylprednisolone 1-2 mg/kg IV (typically 40 mg every 6 hours for a 70 kg adult) can be used as an alternative. 2

Duration and Tapering

• No tapering is required for courses lasting 7-10 days or less. 1, 3
• The 2-3 day course is designed to prevent biphasic reactions (which occur in up to 20% of cases) and late-phase allergic responses. 2, 3
• Courses longer than 10 days may require tapering, especially if patients are not concurrently taking inhaled corticosteroids. 1

Pediatric Dosing

Standard Dosing Regimen

• Administer prednisone or prednisolone 1-2 mg/kg/day orally (maximum 60 mg/day) for 2-3 days. 1, 3
• For less severe allergic episodes (not anaphylaxis), 0.5 mg/kg may be sufficient. 3
• Calculate the dose based on ideal body weight in significantly overweight children to avoid excessive steroid exposure. 3

Alternative Formulations

• Methylprednisolone 1 mg/kg IV (maximum 60-80 mg) can be used if the oral route is not feasible. 3
• For hospitalized children with severe reactions, use 1-2 mg/kg/day divided every 6 hours. 3

Critical Clinical Context

Role as Adjunctive Therapy Only

• Corticosteroids provide NO acute benefit in anaphylaxis—epinephrine 0.3-0.5 mg IM (0.01 mg/kg in children) remains the only first-line treatment. 1, 2, 3
• Corticosteroids are adjunctive therapy to prevent biphasic or protracted reactions, not to treat the acute event. 2, 3
• Never delay or substitute corticosteroids for epinephrine in acute anaphylaxis. 2

Complete Discharge Bundle

• Every patient discharged after an allergic reaction must receive: 2, 3
  • Two epinephrine auto-injectors with hands-on training
  • Prednisone 1 mg/kg daily for 2-3 days
  • H1-antihistamine (diphenhydramine) every 6 hours for 2-3 days
  • H2-antihistamine (ranitidine) twice daily for 2-3 days
  • Written anaphylaxis action plan
  • Follow-up appointment within 1-2 weeks with consideration for allergist referral

Special Considerations

Timing of Administration

• Administer prednisone in the morning (prior to 9 AM) to minimize suppression of the hypothalamic-pituitary-adrenal axis, as maximal adrenal cortex activity occurs between 2 AM and 8 AM. 4
• Take with food or milk to reduce gastric irritation. 4

Patients Requiring Higher Doses or Longer Duration

• Consider higher doses (up to 80 mg daily) and longer duration for patients with: 2, 3
  • History of asthma
  • Severe or prolonged anaphylaxis requiring multiple epinephrine doses
  • Significant generalized urticaria or angioedema
  • History of idiopathic anaphylaxis

Alternative Corticosteroid: Dexamethasone

• A single dose of dexamethasone 12 mg orally can be considered as an alternative to 5 days of prednisone for enhanced compliance, though it narrowly missed noninferiority criteria by a small margin (2.3% difference in relapse rates). 5
• Two days of dexamethasone 16 mg daily was shown to be at least as effective as 5 days of prednisone 50 mg daily in acute asthma exacerbations. 6

Common Pitfalls to Avoid

• Never prescribe corticosteroids alone without epinephrine auto-injectors—this is the most critical error in allergy management. 2
• Do not discharge patients prematurely; observe for at least 4-6 hours after symptom resolution, with longer observation for severe reactions or those requiring multiple epinephrine doses. 2
• Do not extend corticosteroid duration unnecessarily beyond 2-3 days for simple allergic reactions. 2, 3
• Do not use corticosteroids as first-line treatment or delay epinephrine administration in anaphylaxis. 2, 3