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

Abstract

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.

Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey

“…Additionally, it is a common belief, although without any evidence, that corticosteroids could reduce the risk of biphasic and protracted anaphylaxis. [52][53][54] According to the studies, an estimated 1% of hospitalization and 0.1% of ED admissions for anaphylaxis resulted in fatal outcomes. However, mortality in the present study was lower compared to the literature.…”