Corticosteroids for Inflammation Control in the Allergic Child

Corticosteroids are powerful drugs with anti-inflammatory properties, commonly used in treating pediatric allergic diseases. The physiological and pharmacological functions of corticosteroids are mediated by different mechanisms, based on suppression of the genetic transcription of inflammatory cytokines (transrepression), or activation of inhibitory cytokine transcription (transactivation). The onset of action for these mechanisms taking place is usually 4–24 h. Other mechanisms mediated through non-genomic pathways have been studied. These effects are characterized by a rapid onset and short duration of action. Understanding the different mechanisms may help in the development of new and more selective anti-inflammatory drugs paving the way to new strategies in the management of allergic diseases. However, the decision whether or not to administer a corticosteroid for allergic diseases must be based on evidence of efficacy and according to guidelines. There are no convincing data supporting the use of corticosteroids to treat anaphylactic reactions. Oral corticosteroids may be beneficial in children with non-IgE-mediated food allergies, such as eosinophilic esophagitis and food protein-induced enterocolitis. Furthermore, the role of steroids in cutaneous atopic diseases including chronic urticaria and atopic dermatitis has been widely studied. In moderate-to-severe asthma exacerbations, clinical guidelines agree that oral corticosteroids should be promptly administered since they result in fewer and shorter hospitalizations. However, the efficacy in pre-school wheezing is debated. Finally, topical nasal corticosteroids are the treatment of choice for children with persistent allergic rhinoconjunctivitis. Although corticosteroids exert a beneficial effect on the course of several different allergic diseases in childhood, the type of corticosteroid to administer and the appropriate dosage should be carefully evaluated in order to minimize potential adverse effects.