A type of drug known as corticosteroids is used in the treatment of a wide range of diseases, including acute allergic reactions. But recent studies indicate that these medications might not be any more effective at relieving symptoms than safer drugs like antihistamines. In fact, some steroids might actually do more harm than good in treating allergies.
A study published in the Annals of Emergency Medicine added to the growing concern around steroids often prescribed to treat acute allergic reactions like hives. The study involved 100 adults with an itchy rash who were randomly prescribed either prednisone – a common steroid – an antihistamine or a placebo. Researchers found more patients in the placebo group saw their symptoms improve than in the prednisone group, indicating that steroids might not be that effective in treating hives.
The study did have some shortcomings, including the fact that patients self-reported their outcomes and were not clinically examined. In addition, even the prednisone group did not report any more side effects than the other two groups. But researchers said the study underscores what may be a pervasive problem in allergy treatment: Steroids may be prescribed more often than necessary, and therefore cause more negative consequences.
Another recent study published in BMJ looked at the medical records of more than 1.5 million Americans over the course of two years to examine short-term effects of corticosteroids like prednisone and cortisone. In patients taking one of these steroids every day for anywhere from 30 days to five months, the risk of several adverse reactions rose significantly. These negative side effects included:
- Sepsis, or an infection of the blood, was four times more likely.
- Blood clots became three times more common.
- Bone fractures doubled.
These risks increased with higher steroid doses, but could be seen even in patients taking low doses less than once a day.
"While steroids may be appropriate in some situations, like many drugs they have side effects," said the study's lead author, Dr. Akbar K. Waljee, an assistant professor of medicine at the University of Michigan. "We may use them more than we really need to. It is important to minimize their use if alternatives exist."
Steroid alternatives
Alternatives to steroids do exist, and they could provide similarly effective treatment with fewer side effects. For mild allergic reactions, doctors are increasingly prescribing new antihistamines instead of steroids. Antihistamines are widely available in drugs like Benadryl, Claritin, Allegra and other over-the-counter allergy medications. And newer antihistamines for prescription only are showing high levels of effectiveness at treating acute but minor reactions like hives, often with very few side effects.
Steroids do still have a place in allergy treatment, but only for more severe reactions. Cortisone, prednisone and other corticosteroids are derived from hormones that the body produces on its own. When taken as a medication, these drugs work to suppress the immune system and thus reduce inflammation and related side effects. It's been well-established that taking corticosteroids over long periods can cause serious complications, but until recently, they were considered relatively safe for short-term use.
These new studies call that conventional wisdom into question. But it might not be the fault of doctors alone – according to one medical professor who spoke with The New York Times on the study, patients often insist on steroids when being treated for allergic reactions. This could be due to previous experiences with the drug, but doctors may need to learn a new strategy for how to respond to these requests.
