From the FDA Drug Label
The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day). The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses
The recommended steroid dosing for pediatrics for an allergic reaction is 1-2 mg/kg/day in single or divided doses, as recommended by the National Heart, Lung, and Blood Institute (NHLBI) 1.
- The initial dose may vary depending on the specific disease entity being treated.
- The dose range is 0.14 to 2 mg/kg/day in three or four divided doses.
- The treatment duration is usually 3 to 10 days, until symptoms resolve or a peak expiratory flow rate of 80% of the child's personal best is achieved.
From the Research
For pediatric allergic reactions, the recommended steroid is oral prednisone or prednisolone at a dose of 1-2 mg/kg/day (maximum 60 mg daily) for 3-5 days, as supported by the most recent evidence 2.
Key Considerations
- For severe reactions requiring emergency treatment, methylprednisolone can be given intravenously at 1-2 mg/kg/dose (maximum 125 mg).
- These medications help reduce inflammation and suppress the immune response causing the allergic reaction.
- For mild allergic reactions, steroids may not be necessary, and antihistamines like diphenhydramine (Benadryl) at 1-2 mg/kg/dose every 4-6 hours (maximum 50 mg per dose) might be sufficient.
Anaphylaxis Management
- In cases of anaphylaxis, epinephrine is the first-line treatment (0.01 mg/kg of 1:1000 solution, maximum 0.3 mg for children and 0.5 mg for adolescents), with steroids added as adjunctive therapy, as emphasized in recent guidelines 3, 4.
- The use of corticosteroids in anaphylaxis should be revisited, considering the findings of the Cross-Canada Anaphylaxis REgistry data 2.
Monitoring and Side Effects
- When administering steroids, monitor for side effects including increased appetite, mood changes, and elevated blood glucose, especially with longer courses.
- Tapering is typically not required for short courses under 7 days.
- Always assess the severity of the reaction to determine if steroids are appropriate, as they address the inflammatory component but do not reverse the immediate allergic response.
Evidence Summary
- The most recent and highest quality study 2 supports the early use of epinephrine and suggests a beneficial effect of antihistamines in managing anaphylaxis.
- Other studies 5, 6, 3, 4 provide additional context and guidelines for managing allergic reactions and anaphylaxis, but the 2023 study 2 is the most relevant and informative for current practice.