23 Corticosteroids
23.1 Another Major Workhorse
Corticosteroids are highly effective at controlling allergy symptoms and play an integral role in treating allergies. This chapter reviews intranasal, oral, and ocular corticosteroids. It does not cover inhaled or topical corticosteroids.
23.2 What Is This Class of Medication?
These are potent anti-inflammatory medications that result in significant reductions in the release of chemical mediators and decreased recruitment of basophils, eosinophils, and mononuclear cells. These are not histamine blockers and generally do not impact allergy skin testing, with the exception of topical steroids applied to the skin area to be tested.
23.3 What Symptoms Are Good for Treating?
Intranasal corticosteroids: Nasal congestion, rhinorrhea, sneezing, nasal itching, ocular itching, tearing, redness, swelling
Recommended for daily use, there are data that support effectiveness with as needed use.
Oral corticosteroids: Nasal congestion, rhinorrhea, sneezing, nasal and systemic itching, hives, ocular itching, tearing, redness, swelling
Ocular corticosteroids: Tearing, swelling, redness, itching
23.4 Examples of This Class
Intranasal corticosteroids: Fluticasone, flunisolide, mometasone, ciclesonide, budesonide
Oral corticosteroids: Prednisone, methylprednisolone, cortisone, dexamethasone
Ocular corticosteroids: Prednisolone 1%, loteprednol 0.2%, fluorometholone 0.1%
Prednisolone has the greatest anti-inflammatory effect. Fluoromethalone is best for avoiding increased intraocular pressure. Also, consider “soft steroid” eye drops, such as loteprednol. These are new steroid preparations with lower toxicity, better side-effect profile when use is prolonged.
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