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Screening for adrenal suppression urged in children assigned high-dose ICS

The Canadian Society of Allergy and Clinical Immunology recommends physicians screen for adrenal suppression in children receiving high doses of inhaled corticosteroids for more than 6 months, according to a position statement in Allergy, Asthma and Clinical Immunology.

The researchers included data from multiple studies to support their recommendations including a study that reported adrenal suppression in 35% to 65% of children receiving 500 µg ICS or more daily for up to 16 weeks after starting therapy. They said their concern with adrenal suppression is the frequency of unrecognized symptoms such as fatigue, headache, poor growth, hypotension, and hypoglycemia.

The CSACI recommends screening for adrenal suppression if children aged 12 and older are receiving 500 µg ICS or more daily for more than 6 months and if children aged 11 years and younger are receiving 400 µg or more per day.

The society also suggested that if the escalation of asthma treatment is deemed necessary, consultation with an asthma specialist should occur.

“It is important to inform patients and their families about the potential development of adrenal suppression when the patient is treated with high-dose ICS,” Karine Issa-El-Khoury, MD, of McGill University and a member of CSACI, and colleagues wrote.

This appears to be the first position statement to recommend screening for adrenal suppression in children receiving high-dose ICS in North America.

“I’m not aware of a position statement or a work group report in the works on the topic addressed in the Canadian Society of Allergy and Clinical Immunology position statement,” Megan Brown, senior media and member communications manager for the American Academy of Allergy, Asthma and Immunology, told Healio.com/Allergy. –by Ryan McDonald

Disclosure: Issa-El-Khoury reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.