Anaphylaxis Management in Patients on Chronic Steroid Therapy
Introduction to Anaphylaxis Treatment
- The American College of Allergy, Asthma, and Immunology recommends administering epinephrine 0.01 mg/kg IM (maximum 0.5 mg) into the anterolateral thigh as the first-line treatment for anaphylaxis, which should never be delayed to give corticosteroids 3, 4, 5
- The European Academy of Allergy and Clinical Immunology suggests that corticosteroids provide no acute benefit in anaphylaxis management, and their anti-inflammatory effects do not appear for 6-12 hours after administration 4, 5
Steroid Dosing for Anaphylaxis
- For acute anaphylaxis management, the American Academy of Emergency Medicine recommends administering methylprednisolone 1-2 mg/kg IV every 6 hours (typically 40 mg IV every 6 hours for most adults, or 70-140 mg/day total for a 70 kg adult divided into four doses) 1, 2
- The Annals of the Rheumatic Diseases suggest that for patients on chronic medium-dose glucocorticoid therapy, the dosage should be increased for 3 days or switched to intravenous hydrocortisone (starting with two times 25 mg daily for patients on 10 mg prednisone daily, or three times 50 mg daily for patients on higher-dose therapy) 8
Adjunctive Medications
- The American Heart Association recommends administering diphenhydramine 25-50 mg IV (1-2 mg/kg) and ranitidine 50 mg IV or famotidine 20 mg IV (H1 + H2 antagonist combination is superior to H1 alone) as adjunctive medications after epinephrine 1, 2, 3, 4
Post-Acute Management
- The American Academy of Pediatrics suggests monitoring vital signs and observing for at least 6 hours after symptom resolution, with longer observation (up to 24 hours) for severe reactions 1, 2, 3, 4
- The European Respiratory Society notes that biphasic reactions occur in up to 20% of cases, which is why corticosteroids are given despite lack of acute benefit 4, 5