A European review describes cases of allergic reactions, including bronchospasm and anaphylaxis, in patients allergic to cows milk proteins receiving injectable methylprednisolone products containing lactose of bovine origin. In most cases, the patients were younger than 12 years old and had childhood asthma. In some cases, the reaction was mistaken as lack of efficacy, and additional doses of were give with subsequent worsening of the patients condition. The European Union has recommended lactose-containing methylprednisolone products be reformulated to remove any trace of milk proteins by 2019. [ Ref ]
During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.
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