Pediatrician’s Journal —

The Benefits Of Steroids

by Jeff Cersonsky, MD, FAAP

“My son’s doctor wants to put him on a steroid for hay fever. He says that it will be a nasal spray. I thought steroids had so many horrible side-effects. Is this safe?”

In my previous article, I highlighted most of the potential serious effects of abusing steroids. It was pretty scary stuff. Appropriate use of steroids for medical conditions, however, can be enormously helpful and sometimes even life-saving.

There are two main situations where we use steroids for medical purposes. First is where a patient hasn’t enough of his own natural steroids, a condition called adrenal insufficiency. These patients couldn’t survive without supplemental steroids. The steroid levels are monitored regularly to make sure they are receiving the correct amount.

Second, we use steroids as anti-inflammatory drugs. Inflammation is caused when the body gears up its immune system in a part of the body and causes a reaction there. The tissues get swollen, red, and frequently tender. Though inflammation is frequently the bi-product of the body fighting infection, inflammation can also be very harmful, especially when the immune system makes a mistake, fighting the body’s helpful tissues, mistaking them for foreign invaders. Diseases where inflammation is a problem include asthma, hay fever, inflammatory bowel disease, systemic lupus erythematosis (lupus), arthritis, and many others. Appropriate use of steroids in these cases can reduce or eliminate the inflammation, but physicians are careful not to over-use steroids when NSAIDS could be used.

Most of you have heard of the NSAIDS, non-steroidal anti-inflammatory drugs. These include ibuprofen (Advil, Motrin), Aleve, and numerous prescription drugs. These can sometimes be used instead of steroids when inflammation is a problem, thereby avoiding any potential side-effects of the steroids. Many of the NSAIDS, however, have their own list of side-effects and they are not as effective as the steroids. Choosing to use a steroid versus NSAIDS is a risk-benefit decision.

Though nonsteroidal medications can frequently help these illnesses (e.g. antihistamines for hay fever, gold for rheumatoid arthritis, antibiotics for Crohn’s disease), steroids are frequently necessary to either improve the quality of life or preserve life itself.

Steroids can be administered in many ways — nasal sprays, inhalers, injections, pills, etc. How much of the steroid gets in the blood by these different methods affects the potential for side-effects. When a steroid nasal spray is used for hay fever, only a tiny amount of steroids get in the blood, so major side-effects are very rare. This applies similarly to steroid inhalers for asthma. When the steroid is injected into a joint in a patient with arthritis, however, more will be absorbed into the blood than you would get with a steroid inhaler. Taking a steroid by mouth results in even more steroids getting into the bloodstream, increasing the likelihood of side-effects.

For hay fever, the nasal steroid is usually all that is necessary. For asthma, an inhaler containing a steroid is usually sufficient. Short courses of an oral steroid are occasionally necessary for these illnesses when the symptoms can’t be adequately controlled by inhalers. For diseases such as lupus, however, oral steroids are frequently necessary.

To return to the original question, a parent should always question whether a steroid is necessary when it is prescribed. In the situation of using a nasal steroid for hay fever, these drugs can make a huge difference in the quality of life for the recipient, with little potential for side-effects.

 Note: Most of the questions used in my articles are derived from questions I am asked in my practice. I welcome questions from readers, which can be sent to my email address at jmcsdii@erols.com or to my office at 30 Quaker Farms Road, Southbury CT 06488. I cannot respond to all questions nor give medical direction for specific children, but I can give helpful general advice.