Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children

Yao, Tsung Chieh; Wang, Jiu Yao; Chang, Sheng Mao; Chang, Yen Chen; Tsai, Yung-Fong; Wu, Ann Chen; Huang, Jing; Tsai, Hui Ju

doi:10.1001/jamapediatrics.2021.0433

Cited by 43 publications

(33 citation statements)

References 28 publications

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“…In 2021, a group from Taiwan surveyed the medical records of 4.5 million children in their national database and reported an association between oral corticosteroid bursts and increased severe adverse events in children, including gastrointestinal bleeding, sepsis, pneumonia, and glaucoma [29]. Case 13 was diagnosed with poison ivy on the right knee 3 weeks before his bout of meningitis.…”

Section: Corticosteroids and Vzv Reactivationmentioning

confidence: 99%

Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling

Ramachandran

Wilson

Catho

et al. 2021

Viruses

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Varicella vaccine meningitis is an uncommon delayed adverse event of vaccination. Varicella vaccine meningitis has been diagnosed in 12 children, of whom 3 were immunocompromised. We now report two additional cases of vaccine meningitis in twice-immunized immunocompetent children and we perform further testing on a prior third case. We used three methods to diagnose or investigate cases of varicella vaccine meningitis, none of which have been used previously on this disease. These include metagenomic next-generation sequencing and cytokine multiplex profiling of cerebrospinal fluid and immunology exome analysis of white blood cells. In one new case, the diagnosis was confirmed by metagenomic next-generation sequencing of cerebrospinal fluid. Both varicella vaccine virus and human herpesvirus 7 DNA were detected. We performed cytokine multiplex profiling on the cerebrospinal fluid of two cases and found ten elevated biomarkers: interferon gamma, interleukins IL-1RA, IL-6, IL-8, IL-10, IL-17F, chemokines CXCL-9, CXCL-10, CCL-2, and G-CSF. In a second new case, we performed immunology exome sequencing on a panel of 356 genes, but no errors were found. After a review of all 14 cases, we concluded that (i) there is no common explanation for this adverse event, but (ii) ingestion of an oral corticosteroid burst 3–4 weeks before onset of vaccine meningitis may be a risk factor in some cases.

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Section: Corticosteroids and Vzv Reactivationmentioning

confidence: 99%

Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling

Ramachandran

Wilson

Catho

et al. 2021

Viruses

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“…A large case series from Taiwan containing 2,623,327 adults administered brief courses (<14 days) of corticosteroids demonstrated increased incidence of gastrointestinal bleeding, sepsis, and heart failure beginning 5 to 30 days after starting corticosteroid treatments for common medical conditions, with respective absolute risk increases of 10.3, 0.1, and 1 per 1000 patient‐years for each condition 14 . The same group of researchers found a nearly two‐fold increased risk of sepsis, gastrointestinal bleeding, and pneumonia in a nearly 1 million children who had received corticosteroids within the previous year 15 . Other common side effects of short‐term corticosteroids include insomnia, agitation, mood disturbances, and hyperglycemia.…”

Section: Why There Is No Reason To Prescribe Corticosteroids For Anap...mentioning

confidence: 95%

“…14 The same group of researchers found a nearly two-fold increased risk of sepsis, gastrointestinal bleeding, and pneumonia in a nearly 1 million children who had received corticosteroids within the previous year. 15 Other common side effects of short-term corticosteroids include insomnia, agitation, mood disturbances, and hyperglycemia.…”

Section: Why There Is No Reason To Prescribe Corticosteroids For Anap...mentioning

confidence: 99%

Things We Do for No Reason™: Routine use of corticosteroids for the treatment of anaphylaxis

Auth

Zheng

2021

Journal of Hospital Medicine

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Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOA 56-year-old man with coronary artery disease (CAD) undergoes hospital treatment for diverticulitis. He receives ketorolac for abdominal pain upon arrival to the medical ward despite his known allergy to nonsteroidal anti-inflammatory drugs. Fifteen minutes after administration, he develops lightheadedness and experiences swelling of his lips. On exam, he has tachycardia and a diffuse urticarial rash across his torso. The admitting physician prescribes methylprednisolone, diphenhydramine, and a liter bolus of normal saline for suspected anaphylaxis. Epinephrine is not administered for fear of precipitating an adverse cardiovascular event given the patient's history of CAD.

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“…73,75 In addition, there is a risk of adverse events, even with short use of systemic steroids in children, including vomiting, sleep disturbance, and behavioral changes, 76 as well as a risk of gastrointestinal bleeding, pneumonia, and sepsis. 77 Guideline recommendations about the use of corticosteroids in anaphylaxis remain mixed. The AAAAI position paper on the management of anaphylaxis in childhood notes the use of corticosteroids to be "questionable," 52,78 and the 2021 Australian guidelines note 'the benefit of corticosteroids in anaphylaxis is "unproven."…”

Section: Systemic Corticosteroids Do Not Prevent Biphasic Anaphylaxis...mentioning

confidence: 99%

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Abrams

Greenhawt

Shaker³

et al. 2022

The Journal of Pediatrics

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Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children

Cited by 43 publications

References 28 publications

Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling

Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling

Things We Do for No Reason™: Routine use of corticosteroids for the treatment of anaphylaxis

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

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