Corticosteroids are indicated in severe systemic allergic reactions when intravenous hydrocortisone may be needed followed by a short course of oral steroids. Rarely, in patients with severe atopic allergy to multiple foods or where causative food(s) are not known and symptoms are severe, systemic steroids can be used on a long-term basis. The dose should be kept to a minimum because of the well-known side effects. These side effects can be explained by the mineralocorticoid or glucocorticoid activity (Table 5.5) of these substances. Different steroids vary in their glucocorticoid (anti-inflammatory) and mineralocorticoid (water retaining) effects. Hydrocortisone is less potent than others in its anti-inflammatory activity but is administered by intravenous injection for acute systemic reactions in addition to adrenaline. Prednisolone has more potent glucocorticoid activity and is often used if oral therapy is required. Other steroids such as betamethasone and dexamethasone have very high glucocorticoid activity and may be used for long-term therapy.

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