There are many “unanswered” questions in Pediatric EM where the scientific literature does not have a good, definitive answer. Whether to use or not to use steroids in anaphylaxis is one of them. Sophia Wang (our PEM fellow from previous episodes) looked into it.

Here are some of the articles Sophia used in her research

Alqurashi W, Ellis AK. Do Corticosteroids Prevent Biphasic Anaphylaxis?. J Allergy Clin Immunol Pract. 2017;5(5):1194-1205. doi:10.1016/j.jaip.2017.05.022

Gaffney LK, Porter J, Gerling M, Schneider LC, Stack AM, Shah D, Michelson KA. Safely Reducing Hospitalizations for Anaphylaxis in Children Through an Evidence-Based Guideline. Pediatrics. 2022 Feb 1;149(2):e2020045831. doi: 10.1542/peds.2020-045831. PMID: 35059724; PMCID: PMC9250079.

Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi:10.1016/j.anai.2015.07.019

Michelson KA, Dribin TE, Vyles D, Neuman MI. Trends in emergency care for anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(2):767-768.e2. doi:10.1016/j.jaip.2019.07.018

Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017

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Sometimes it is good to give your patients (or parents) some options regarding their care (some people call it shared decision making). How a short conversation can help you better understand your patients and their needs.

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