Steroids in anaphylactic shock

Steroids in anaphylactic shock:

• routine use of corticosteroids to treat anaphylaxis is not advised
• consider giving steroids after initial resuscitation for refractory reactions or ongoing asthma/shock

Steroids must not be given preferentially to adrenaline (1):

• primary action of corticosteroids is the downregulation of the late-phase (rather than early-phase) inflammatory response. However, there is little evidence that corticosteroids help shorten protracted symptoms or prevent biphasic reactions
• there are emerging data suggesting that early use of steroids is associated with an increased risk of intensive care admission, even after adjusting for severity of presenting symptoms
• in asthma, early corticosteroid treatment may be beneficial in adults and children
  • corticosteroids may be indicated where an acute asthma exacerbation may have contributed to the severity of anaphylaxis
  • steroids should be given by the oral route where possible
  • refer to the BNF for Children to find information on appropriate dosing

Reference:

1. Emergency treatment of anaphylactic reactions.Guidelines for healthcare providers.Working Group of the Resuscitation Council (UK) 2021.