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steroids in anaphylactic shock

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Steroids in anaphylactic shock

  • routine use of corticosteroids to treat anaphylaxis is not advised
  • consider giving steroids after initial resuscitation for refractory reactions or ongoing asthma/shock

Steroids must not be given preferentially to adrenaline (1):

  • primary action of corticosteroids is the downregulation of the late-phase (rather than early-phase) inflammatory response. However, there is little evidence that corticosteroids help shorten protracted symptoms or prevent biphasic reactions
  • are emerging data suggesting that early use of steroids is associated with an increased risk of intensive care admission, even after adjusting for severity of presenting symptoms
  • in asthma, early corticosteroid treatment may be beneficial in adults and children
    • corticosteroids may be indicated where an acute asthma exacerbation may have contributed to the severity of anaphylaxis
    • steroids should be given by the oral route where possible
    • refer to the BNF for Children to find information on appropriate dosing


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