Patient Education

USE OF STEROID MEDICATIONS FOR ALLERGIES, ASTHMA, AND RELATED CONDITIONS

Copyright 2000, Regional Allergy & Asthma Consultants, PA

OVERVIEW

Corticosteroid medications have been used to treat asthma and allergic reactions for over 50 years.  When used properly and under physician supervision, they can be among the most safe and effective therapies for many of the conditions we treat. 

TYPES OF STEROIDS

There are two kinds of steroids: 1) Anabolic steroids, sometimes used by athletes to build muscle mass and enhance performance; and 2) corticosteroids, used by physicians to treat inflammatory conditions, such as arthritis, asthma, and allergies.  These are really two different types of steroids; corticosteroids are structurally similar to the steroids your body produces every day and do not cause the effects seen with anabolic steroids.  Corticosteroids may be given systemically (by pill, syrup, or injection) and locally (creams and ointments, nasal sprays, or inhalers).  We usually prescribe steroids by the local route since this greatly reduces the likelihood of side effects.  Patients with flare-ups of their allergies and asthma, however, occasionally require systemic steroids for maximal treatment. 

WHAT IS THE FUNCTION OF CORTICOSTEROIDS?

Inflammation is the hallmark of most allergic diseases, including allergic rhinitis (hay fever), asthma, nasal polyps, atopic dermatitis, and hives.  Inflammation causes redness, swelling, itch, and burning, and in the nose and lungs, mucus production as well.  Medications that reduce this process are termed anti-inflammatory, and corticosteroids are among the most effective anti-inflammatory medications available today.

POTENTIAL SIDE EFFECTS OF SYSTEMIC STEROIDS

Corticosteroids given by pill, syrup, or injection reach the blood stream and thus have potential to cause side effects on other parts of the body in addition to their desired effect of reducing inflammation.  These side effects include fluid retention, increased appetite, weight gain, upset stomach, increase in blood sugar, increase in blood pressure, increase in eye pressure, mood swings, and sleep disturbance.  These side effects gradually disappear once the steroids are tapered or stopped.  There are no lasting effects of short courses of steroids to control flare-ups of allergies or asthma.  An extremely rare complication of systemic steroids is hip damage with affected persons noting progressive and rather intense hip pain.

Persons who require systemic steroids on a fairly regular basis (daily or every other day) are at risk for additional side effects.  These include reduced growth (in children), loss of bone density (osteoporosis), and increased risk of cataracts.

Because of the potential for side effects from systemic steroids, we always weigh the risks of treatment against the risks of progressive disease and attempt to use the lowest possible dose for the shortest period of time.  When appropriate, we will recommend preventive strategies to minimize the need for future courses of systemic steroids.  These may include topical or inhaled corticosteroids, non-steroid medications, allergy immunotherapy injections, and environmental control.

POTENTIAL SIDE EFFECTS OF INHALED OR TOPICAL STEROIDS

The development of steroid medications which can be administered directly to the site of inflammation, with little or no absorption into the bloodstream, has revolutionized the use of steroids in medicine.  We use these preparations routinely in the treatment of our patients with allergies, sinusitis, and/or asthma, and generally do so instead of using systemic steroids.  They may be given as creams for eczema, nasal sprays for allergies or sinus problems, and as inhalers for asthma. 

In general, inhaled and topical steroids are very well tolerated.  As with any medication, there is potential for side effects.  Most side effects, however, occur at the site of application.  Steroid creams, particularly those of higher potency, may cause thinning of the skin in areas where applied chronically.  Steroid nasal sprays may occasionally cause nasal irritation or bleeding, and should be temporarily stopped if this occurs.  Steroid inhalers for asthma occasionally cause irritation of the throat, hoarseness, or thrush.  These usually can be prevented with adequate rinsing, gargling, and use of a spacer. 

Inhaled or topical steroids may rarely cause systemic side effects, particularly when used at higher doses over long periods of time.  The use of certain inhaled steroids has been associated with a subtle decrease in growth velocity in some children, and a subtle decrease in bone density, increase in intraocular pressure (glaucoma) and/or cataract formation in some adults.  Balancing these concerns are the alternatives of not treating with topical or inhaled steroids resulting in poor disease control, decreased quality of life, and the increased likelihood for flare-ups eventually requiring systemic steroids. 

As always, we will work closely with you to determine the best overall treatment program for you, carefully balancing the risks and benefits of all potential therapies, including environmental control, steroid and nonsteroid medications, and immunotherapy injections.  Please call us at any time if you have questions about your treatment. 

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