From the Research
The maximum dose of prednisone for anaphylaxis is typically 40-60 mg daily for adults, administered orally, but the most recent and highest quality study suggests that corticosteroid use in anaphylaxis should be revisited 1. In acute anaphylaxis, injectable corticosteroids like methylprednisolone (125-250 mg) or hydrocortisone (200-500 mg) are preferred due to their faster onset of action. Prednisone is generally used as a follow-up medication after the acute phase has been managed with epinephrine (the first-line treatment), antihistamines, and injectable corticosteroids. For children, the prednisone dose is usually 1-2 mg/kg/day (maximum 60 mg). The duration of prednisone treatment for anaphylaxis is typically short, around 3-5 days, to prevent biphasic or protracted reactions. Corticosteroids work by suppressing the inflammatory response and preventing the late-phase allergic reaction, though they do not act quickly enough to be the primary treatment for the immediate symptoms of anaphylaxis. Some key points to consider in anaphylaxis management include:
- Epinephrine is the first-line treatment for any type of anaphylaxis and is recognized as the only medication documented to prevent hospitalizations, hypoxic sequelae, and fatalities 2.
- Antihistamines and corticosteroids should be used only as third-line treatment, and their administration should never delay adrenaline injection in anaphylaxis 2.
- The use of corticosteroids in anaphylaxis has been evaluated in several studies, with some suggesting that they may reduce the length of hospital stay, but there is no consensus on whether they reduce biphasic anaphylactic reactions 3.
- A recent study suggests that patients who received prehospital corticosteroids were more likely to require intravenous fluids in ED and be admitted, which may indicate that corticosteroid use in anaphylaxis should be revisited 1. It's essential to prioritize epinephrine as the primary intervention in a comprehensive anaphylaxis management plan.