Intravenous corticosteroids: Adverse reactions are more variable than expected in children

Objective: To determine the frequency and severity of adverse reactions associated with high dose intermittent intravenous corticosteroids (IVCS) in children with rheumatic disease. Methods: Prospective documentation of adverse reactions associated with IVCS given to 213 pediatric rheumatology patients over a 4 year period. Results. Forty-six of the 213 children (22%) reported an adverse reaction. The 46 patients received 2622 doses of IVCS. Twenty-one patients (10% of all patients studied) had behavioral changes, including altered mood (14), hyperactivity (4), psychosis (2), disorientation (1), and sleep disturbances (3). Nonbehavioral adverse reactions included headache (5.2%), abdominal complaints (4.7%), pruritus (4.2%), vomiting (3.8%), hives (2.3%), hypertension (2.3%), bone pain (1.5%), dizziness (1.5%), fatigue (1%), lethargy (1%), hypotension (1%), tachycardia (1%), hyperglycemia (1%), fracture (1%), tremor (0.5%), anaphylaxis (0.5%), ulcer (0.5%), and 'gray appearance'(0.5%). Using chi-squared analysis, there were no statistical differences in ethnicity (p = 0.54) or diagnosis (p = 0.46) between patient groups, with or without adverse reactions. There was a significant statistical association between history of drug induced cutaneous reaction and adverse reactions to IVCS (p < 0.01). Conclusion. IVCS are associated with a spectrum of adverse reactions in children with rheumatic disease, of which volatile behavior is the most frequent. Children with a history of drug induced cutaneous reaction are more likely to have an adverse reaction to IVCS.